{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T12:57:24Z","timestamp":1769518644153,"version":"3.49.0"},"reference-count":31,"publisher":"S.C. JURNALUL PENTRU MEDICINA SI VIATA S.R.L","issue":"3","license":[{"start":{"date-parts":[[2019,7,1]],"date-time":"2019-07-01T00:00:00Z","timestamp":1561939200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMedLife"],"abstract":"<jats:p>Hysterectomy is the most common gynecological surgical intervention; therefore, there are many technical variations in different healthcare systems around the world. We aimed to review, step by step, the technique of laparoscopic hysterectomy as well as to present the available variety of surgical instruments impartially so that the operative team can decide in an informed manner the model and characteristics of the equipment used. The surgical technique is presented based on the experience of the authors, focusing mainly on intraoperative recommendation and suggestions. Advantages and disadvantages of the available instruments are also extensively detailed. Surgical positioning, as well as inserting the uterine manipulator are essential steps. The open technique is used to create pneumoperitoneum. The utero-ovarian ligament or the infundibulopelvic ligament is identified, coagulated and cut. The round ligament is incised, entering the space between the two layers of the broad ligament and advancing caudally in this space, which, if correctly identified, should be avascular. The uterine vessels located on the posterior sheet of the broad ligament are dissected and coagulated. The vaginal wall is sectioned with the help of the manipulator\u2019s cap, making it easier to expose the insertion line of the vagina on the cervix. The uterus is removed through the vagina or through a trans-parietal incision. Thereafter, the vagina is sutured using separate Vicryl sutures. Between 2011 and 2016, laparoscopic hysterectomy had an increasing trend all over Europe. With a reported percentage of 3%, Romania ranks last in hysterectomies performed laparoscopically. The laparoscopic approach offers the advantages of minimal invasiveness: less pain, faster recovery and early social reintegration; therefore, this trend of improvement should become more accepted.<\/jats:p>","DOI":"10.25122\/jml-2019-0051","type":"journal-article","created":{"date-parts":[[2019,11,15]],"date-time":"2019-11-15T10:43:27Z","timestamp":1573814607000},"page":"301-307","source":"Crossref","is-referenced-by-count":8,"title":["Laparoscopic total hysterectomy still not routinely chosen Operative description and available instruments"],"prefix":"10.25122","volume":"12","author":[{"given":"Alexandra","family":"Popa","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Obstetrics & Gynecology Department, Emergency University Hospital, Bucharest, Romania","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Alexandra Popa, Emergency University Hospital, Splaiul Independentei Street, no. 169, 050098, Bucharest, Romania, E-mail: md.alexandra.popa@gmail.com","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catalin","family":"Copaescu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"General Surgery Department, Ponderas Hospital, Bucharest, Romania","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valerica","family":"Horhoianu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Obstetrics & Gynecology Department, Emergency University Hospital, Bucharest, Romania","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10755","published-online":{"date-parts":[[2019,7]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","unstructured":"Farquhar C, Steiner CA. Hysterectomy rates in the United States. Obstet. Gynecol. 99,229\u2013234 (2002).","DOI":"10.1097\/00006250-200202000-00012"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"Materia E, Rossi L, Spadea T et al. Hysterectomy and socioeconomic position in Italy. J. Epidemiol. Community Health 56,461\u2013465 (2002).","DOI":"10.1136\/jech.56.6.461"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"Gimbel H, Settnes A, Tabor A. Hysterectomy on benign indication in Denmark 1988-1998. A register based trend analysis. Acta Obstet Gynecol Scand 2001;80:267\u201372.","DOI":"10.1034\/j.1600-0412.2001.080003267.x"},{"key":"ref4","doi-asserted-by":"crossref","unstructured":"Lundholm C, Forsgren C, Johansson AL et al. Hysterectomy on benign indications in Sweden 1987-2003: a nationwide trend analysis. Acta Obstet Gynecol Scand 2009;88:52\u20138.","DOI":"10.1080\/00016340802596017"},{"key":"ref5","unstructured":"Lepine LA, Hilis SD, Marchbanks PA et al. Hysterectomy surveillance \u2013United States, 1980\u20131993. MMWR CDC Surveill. Summ. 46,1\u201315 (1997)."},{"key":"ref6","doi-asserted-by":"crossref","unstructured":"Wilcox LS, Kononin LM, Pokras R, Strauss LT, Xia Z, Peterson HB. Hysterectomy in the United States, 1988\u20131990. Obstet. Gynecol. 83,549\u2013555 (1994).","DOI":"10.1097\/00006250-199404000-00011"},{"key":"ref7","unstructured":"Keshavarz H. Hysterectomy surveillance \u2013 United States, 1994\u20131999. MMWR Surveill. Summ. 51,1\u20138 (2002)."},{"key":"ref8","doi-asserted-by":"crossref","unstructured":"Jacobson GF, Shaber RE, Armstrong MA, Hung YY. Hysterectomy rates for benign indications. Obstet. Gynecol. 107(6),1278\u20131283 (2006).","DOI":"10.1097\/01.AOG.0000210640.86628.ff"},{"key":"ref9","unstructured":"https:\/\/ec.europa.eu\/eurostat\/statisticsexplained\/index.php\/title.Surgical_operations_and_proce-dures"},{"key":"ref10","doi-asserted-by":"crossref","unstructured":"Englund M, Robson S Why has the acceptance of laparoscopic hysterectomy been slow? Results of an anonymous survey of Australian gynecologists. J Minim Invasive Gynecol. 2007 Nov-Dec; 14(6):724\u20138.","DOI":"10.1016\/j.jmig.2007.07.007"},{"key":"ref11","doi-asserted-by":"crossref","unstructured":"Treszezamsky AD, Fenske S, Moshier EL, Ascher-Walsh CJ. Neurologic injury and patient displacement in gynecologic laparoscopic surgery using a beanbag and shoulder supports. Int J Gynaecol Obstet. 2018 Jan;140(1):26\u201330","DOI":"10.1002\/ijgo.12325"},{"key":"ref12","unstructured":"Jon I Einarsson, MPH and Yoko Suzuki, Total Laparoscopic Hysterectomy: 10 Steps Toward a Successful Procedure. Rev Obstet Gynecol. 2009 Winter; 2(1): 57\u201364."},{"key":"ref13","unstructured":"Hurd W, Falcone, Rivlin M. Gynecologic Laparoscopy Treatment and Management. https:\/\/emedicine.medscape.com\/article\/265201-treatment"},{"key":"ref14","doi-asserted-by":"crossref","unstructured":"V.P. Lamaro, J.D. Broome, T.G. Vancaillie Unrecognized bladder perforation during operative laparoscopy. J. Am. Assoc. Gynecol. Laparosc., 7(3) (2000), pp. 417\u2013419.","DOI":"10.1016\/S1074-3804(05)60490-2"},{"key":"ref15","doi-asserted-by":"crossref","unstructured":"A. Ostrzenski, K.M. Ostrzenska Bladder injury during laparoscopic surgery. Obstet. Gynecol. Surv., 53(3) (1998), pp. 175\u2013180.","DOI":"10.1097\/00006254-199803000-00023"},{"key":"ref16","doi-asserted-by":"crossref","unstructured":"Dawkins J.C, Lewis G.K, Christensen B, Wortman M. Urinary ascites in late onset of bladder injury post laparoscopic hysterectomy. Case Rep Womens Health. 2017 Sep 22;16:8\u201310","DOI":"10.1016\/j.crwh.2017.09.001"},{"key":"ref17","unstructured":"Steiner RA, Wight E, Tadir Y, Haller U. Electrical cutting device for laparoscopic removal of tissue from the abdominal cavity. Obstet Gynecol. 1993 Mar; 81(3):471\u20134."},{"key":"ref18","unstructured":"Morcellator, Jude S. Sauer, Roger J. Greenwald, Mark A. Bovard, John F. Hammond - US Patent 5562694. Issue date: Oct 8, 1996."},{"key":"ref19","unstructured":"Disposable laparoscopic morcellator, GM Savage, JJ Christian, DC Dillow - US Patent 6,039,748, 2000"},{"key":"ref20","unstructured":"FDA, FDA discourages use of laparoscopic power morcellation for removal of uterus or uterine fibroids. Food Drug Adm. 2014;17:4."},{"key":"ref21","doi-asserted-by":"crossref","unstructured":"Hans Br\u00f6lmann, Vasilios Tanos, Grigoris Grimbizis, Thomas Ind, Kevin Philips, Thierry van den Bosch, Samir Sawalhe, Lukas van den Haak, Frank-Willem Jansen, Johanna Pijnenborg, Florin-Andrei Taran, Sara Brucker, Arnaud Wattiez, Rudi Campo, Peter O\u2019Donovan, Rudy Leon de Wilde, and On behalf of the European Society of Gynaecological Endoscopy (ESGE) steering committee on fibroid morcellation. Options on fibroid morcellation: a literature review. Gynecol Surg. 2015; 12(1): 3\u201315.","DOI":"10.1007\/s10397-015-0878-4"},{"key":"ref22","doi-asserted-by":"crossref","unstructured":"Rowland M, Lesnoch J, Edwards R, Richard S, Zom K, Sukumvanich P. Occult uterine cancer in patients undergoing laparoscopic hysterectomy with morcellation. Gynecol Oncol. 2012;127(1):S29.","DOI":"10.1016\/j.ygyno.2012.07.080"},{"key":"ref23","doi-asserted-by":"crossref","unstructured":"Bojahr B, De Wilde RL, Tchartchian G. Malignancy rate of 10,731 uteri morcellated during laparoscopic supracervical hysterectomy (LASH). Arch Gynecol Obstet. 2015 Sep; 292(3):665\u201372.","DOI":"10.1007\/s00404-015-3696-z"},{"key":"ref24","unstructured":"Harlow BL, Weiss NS, Lofton S. The epidemiology of sarcomas of the uterus. J Natl Cancer Inst. 1986 Mar; 76(3):399\u2013402."},{"key":"ref25","doi-asserted-by":"crossref","unstructured":"Multinu F, Casarin J, Tortorella L, Huang Y, Weaver A, Angioni S, Melis GB, Mariani A, Stewart EA, Laughlin-Tommaso SK. Incidence of sarcoma in patients undergoing hysterectomy for benign indications: a population-based study. Am J Obstet Gynecol. 2019 Feb;220(2):179.e1\u2013179.","DOI":"10.1016\/j.ajog.2018.11.1086"},{"key":"ref26","doi-asserted-by":"crossref","unstructured":"K.A. Shibley, Feasibility of Intra-Abdominal Tissue Isolation and Extraction, within an Artificially Created Pneumoperitoneum, at Laparoscopy for Gynecologic Procedures. J Minim Invasive Gynecol. 2012;19[6]:[Suppl] S75.","DOI":"10.1016\/j.jmig.2012.08.584"},{"key":"ref27","doi-asserted-by":"crossref","unstructured":"Anapolski M, Panayotopoulos D, Alkatout I, Soltesz S, Mettler L, Schiermeier S, Hatzmann W, No\u00e9 G. Power morcellation inside a secure endobag: a pilot study. Minim Invasive Ther Allied Technol. 2016 Aug;25(4):203\u20139.","DOI":"10.1080\/13645706.2016.1176932"},{"key":"ref28","doi-asserted-by":"crossref","unstructured":"Anapolski M, Panayotopoulos D, Alkatout I, Soltesz S, Schiermeier S, No\u00e9 G. Preclinical safety testing for morcellation and extraction for an endobag with sealable ports: in vitro pilot study. Surg Endosc. 2017 Jan;31(1):494\u2013500.","DOI":"10.1007\/s00464-016-4969-8"},{"key":"ref29","doi-asserted-by":"crossref","unstructured":"Devassy R, Cezar C, Krentel H, Verhoeven HC, Devassy R, de Wilde MS, Torres-de la Roche LA, de Wilde RL. Feasibility of myomatous tissue extraction in laparoscopic surgery by contained in - bag morcellation: A retrospective single arm study. Int J Surg. 2019 Feb;62:22\u201327.","DOI":"10.1016\/j.ijsu.2018.12.013"},{"key":"ref30","doi-asserted-by":"crossref","unstructured":"Favero G. Tips and tricks for successful manual morcellation: a response to \u201cvaginal morcellation: a new strategy for large gynecological malignant tumors extraction. A pilot study\u201d. Gynecol Oncol. 2013 Jan; 128(1):151.","DOI":"10.1016\/j.ygyno.2012.09.028"},{"key":"ref31","unstructured":"ACOG Committee Opinion No. 770: Uterine Morcellation for Presumed Leiomyomas. Obstet Gynecol. 2019 Mar;133(3):e238\u2013e248."}],"container-title":["Journal of Medicine and Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/medandlife.org\/wp-content\/uploads\/JMedLife-12-301.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,24]],"date-time":"2021-12-24T03:41:00Z","timestamp":1640317260000},"score":1,"resource":{"primary":{"URL":"https:\/\/medandlife.org\/wp-content\/uploads\/JMedLife-12-301.pdf"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,7]]},"references-count":31,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2019,7]]}},"alternative-id":["JMedLife-12-301"],"URL":"https:\/\/doi.org\/10.25122\/jml-2019-0051","relation":{},"ISSN":["1844-122X","1844-3117"],"issn-type":[{"value":"1844-122X","type":"print"},{"value":"1844-3117","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,7]]}}}