title: [Poor vaginal access: excellent indication for laparoscopic hysterectomy].
abstract: OBJECTIVE
  The great majority of hysterectomies in patients without previous vaginal delivery have been carried out via laparotomy. The purpose of this study was to establish whether laparoscopic surgery can be of use in an attempt to reduce the number of laparotomies for patients with no previous vaginal delivery who underwent an hysterectomy indicated for benign pathologies.
  
  
  METHODS
  A retrospective study was carried out on 116 patients who had not had a previous vaginal delivery who underwent hysterectomy from January 1993 to December 1996.
  
  
  RESULTS
  Laparotomy was required for only 20.7% of cases (24 patients). For the 92 patients (79.3%) who underwent laparoscopic hysterectomy, the average duration of the operation was 145 +/- 44 min (range: 60-290) and the mean uterine weight was 200 +/- 130 g (range: 30-840).
  
  
  CONCLUSIONS
  These results demonstrate that laparoscopic surgery decreased significantly the number of laparotomies necessary for patients without previous vaginal delivery who require hysterectomy. When vaginal access is poor, simple laparoscopic preparation is inadequate and the only possibility of avoiding laparotomy is to carry out the hysterectomy entirely via laparoscopic route.
authors.affiliation: Service de Chirurgie Gynécologique, Clinique Universitaire Baudelocque, CHU Cochin Port Royal, Paris.
authors.forename: C
authors.initials: C
authors.lastname: Chapron
authors.forename: J B
authors.initials: JB
authors.lastname: Dubuisson
authors.forename: Y
authors.initials: Y
authors.lastname: Ansquer
authors.forename: B
authors.initials: B
authors.lastname: Fernandez
mesh_terms: D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy; D007902:Length of Stay / Q000706:statistics & numerical data; D008875:Middle Aged; D010298:Parity; D018579:Patient Selection; D012189:Retrospective Studies; D013997:Time Factors; D014591:Uterine Diseases / Q000601:surgery*
vernacular_title: La mauvaise accessibilité vaginale: excellente indication de la coeliochirurgie pour réaliser une hystérectomie.