Laparoscopically assisted vaginal hysterectomy following previous kidney transplantation.
OBJECTIVE
With improvements in immunosuppression and surgical techniques, more women are undergoing kidney transplantation (KT) for management of end-stage renal disease. Location of the transplanted pelvic kidney and transplanted ureter must be taken into consideration when performing pelvic surgery. We demonstrate that laparoscopically assisted vaginal hysterectomy (LAVH) can be successfully performed in patients who had previously undergone KT.


METHODS
We prospectively enrolled four patients requiring operation for symptomatic adenomyosis after KT. LAVH was performed in these cases after initial uterine artery ligation during laparoscopy.


RESULTS
The median age of the patients was 44 years (range, 40-46 years) and the extirpated uterine weight was 195 g (range, 160-380 g). Intraoperatively, the median operation time was 147.5 minutes (range, 105-175 minutes) and the blood loss was 50 mL (range, 50-100 mL). There was mild pelvic adhesion in two cases. The postoperative recovery was good in all patients with oral intake, flatus passage, and ambulation within 1 day after operation. The median intramuscular meperidine requirements were 25 mg (range, 0-100 mg) and the hospital stay was 4 days (range, 3-8 days). There were no major complications in these cases except one with mild postoperative fever.


CONCLUSIONS
LAVH may be a safe and effective treatment for treating patients with adenomyosis after KT.
Department of Obstetrics and Gynecology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
Szu-Yu
SY
Chen
Su-Cheng
SC
Huang
Bor-Ching
BC
Sheu
Daw-Yuan
DY
Chang
Li-Yun
LY
Chou
Wen-Chiung
WC
Hsu
Wen-Chun
WC
Chang
D000328:Adult; D004715:Endometriosis / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D016030:Kidney Transplantation; D010535:Laparoscopy; D007902:Length of Stay; D008026:Ligation; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy; D011446:Prospective Studies; D055988:Uterine Artery / Q000601:surgery*