Uterine manipulator in total laparoscopic hysterectomy: safety and usefulness
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ORIGINAL ARTICLE
Uterine manipulator in total laparoscopic hysterectomy: safety and usefulness Yara Abdel Khalek1 · Roger Bitar2 · Costas Christoforou3 · Simone Garzon4 · Alessandro Tropea5 · Antonio Biondi6 · Zaki Sleiman1,2 Received: 14 July 2019 / Accepted: 21 September 2019 © Italian Society of Surgery (SIC) 2019
Abstract The aim of this review is to evaluate the effectiveness and safety of uterine manipulators in facilitating total laparoscopic hysterectomy (TLH). A literature search in MEDLINE, EMBASE, Cochrane Library, UpToDate, SpringerLink, ClinicalKey and Elsevier ScienceDirect databases was performed, and articles describing TLH with or without the use of uterine manipulators were retrieved. Complications related to the use of uterine manipulators are numerous, and although uterine manipulator seems to facilitate TLH, the procedure without a uterine manipulator seems to have a comparable safety and effectiveness, although evidence based on a direct comparison of the two approaches is limited without available controlled trials. Uterine manipulator may provide support in cases of large uteri, severe endometriosis, recto vaginal adhesions and regional anesthesia, while its use may increase complications in cases of vaginal stenosis and nulliparity. Therefore, to perform TLH, the surgeon should individualize for each case if uterine manipulator is needed and which manipulator best suits the surgical procedure requirements and case characteristics. Further studies comparing the two approaches are mandatory. Keywords Hysterectomy · Laparoscopy · Uterine manipulator · Surgical Instruments · Intraoperative complications
Introduction Hysterectomy is the most common gynecological surgical procedure, and it is performed to treat several benign (85–90%) and malignant (10%) pathologies [1]. Since the late 1980s, with the development of new minimally invasive * Zaki Sleiman [email protected] 1
Department of Obstetrics and Gynecology, Saint Joseph University, Beirut, Lebanon
2
Department of Obstetrics and Gynecology, Lebanese American University, Zahar Street, Beirut, Lebanon
3
Christoforou Clinic, Larnaca, Cyprus
4
Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, Varese, Italy
5
Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT(Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), University of Pittsburgh Medical Center Italy, Palermo, Italy
6
Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
laparoscopic technique, the conventional laparotomic and vaginal approaches for hysterectomy were replaced by total laparoscopic hysterectomy (TLH), with the first case published in 1993 [2]. TLH gained a rapid popularity since it is associated with high rate of patient satisfaction, allowing rapid recovery and less postoperative pain and hospital stay, that is particularly useful in fragile patients [3, 4]. Surgeons, as well,
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