title: Needlescopic hysterectomy: incorporation of 3-mm instruments in total laparoscopic hysterectomy.
abstract: BACKGROUND
  Progression to needlescopic techniques for advanced gynecologic procedures currently performed with conventional laparoscopy still is in its infancy, and published series are currently lacking in the gynecologic literature. This study aimed to report initial experience with incorporating needlescopic instruments in the performance of total laparoscopic hysterectomy (TLH).
  
  
  METHODS
  The study group consisted of 32 consecutive women undergoing needlescopic hysterectomy. The control group included 54 women who underwent conventional TLH over the preceding 12-month period and met the same inclusion criteria as the study group. Conventional TLH was performed using 5-mm working ports and a 10-mm laparoscope. The needlescopic hysterectomy differed from the conventional laparoscopic procedure in that 3-mm working ports were used as well as a 3- or 5-mm laparoscope at the umbilicus. Otherwise, the trocar layout and surgical technique were identical. Parameters of technical feasibility (operating time, estimated blood loss, perioperative complications) were considered major statistical end points.
  
  
  RESULTS
  In the study group, all but one procedure were performed successfully using the needlescopic approach. One patient in the needlescopic group required conversion to standard TLH because of uncontrollable bleeding from the uterine artery. The operative time and estimated blood loss of needlescopic hysterectomy were comparable with those of standard TLH. No significant complication occurred in either group.
  
  
  CONCLUSIONS
  For properly selected patients, the needlescopic technique can be applied to TLH safely and effectively.
authors.affiliation: Department of Obstetrics and Gynecology, University of Insubria, Piazza Biroldi 1, 21100 Varese, Italy. fabio.ghezzi@uninsubria.it
authors.forename: Fabio
authors.initials: F
authors.lastname: Ghezzi
authors.forename: Antonella
authors.initials: A
authors.lastname: Cromi
authors.forename: Gabriele
authors.initials: G
authors.lastname: Siesto
authors.forename: Luigi
authors.initials: L
authors.lastname: Boni
authors.forename: Stefano
authors.initials: S
authors.lastname: Uccella
authors.forename: Valentino
authors.initials: V
authors.lastname: Bergamini
authors.forename: Pierfrancesco
authors.initials: P
authors.lastname: Bolis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004867:Equipment Design; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D020706:Laparoscopes; D010535:Laparoscopy; D008875:Middle Aged; D009339:Needles