title: Total laparoscopic hysterectomy without uterine manipulator: description of a new technique and its outcome.
abstract: BACKGROUND
  Hysterectomy remains the most common major gynecological operation. This is the first study that describes a new technique of TLH without using any kind of uterine manipulator or vaginal tube (TLHwM) and analyzes the intra- and postoperative surgical outcome of the first 67 cases.
  
  
  METHODS
  Between October 2008 and December 2009, 67 patients underwent TLH without uterine manipulator or vaginal tube. We analyzed the differences in the outcome by using three different kinds of surgical instruments: in 21 cases the TLHwM was performed using conventional 5 mm bipolar and scissors, in 22 cases using Sonosurgical, and in 24 cases using PKS cutting forceps.
  
  
  RESULTS
  There was no intra- or postoperative complications. The overall mean operating time was by TLHwM with salpingo-oophorectomy 98 min and without salpingo-oophorectomy, 80 min. The mean operating time using cutting forceps was significantly lower. The mean uterine weight was 263 g.
  
  
  CONCLUSIONS
  Uterine manipulator seems to be a safe and practical surgical method, especially for patients with vaginal stenosis and in cases of enlarged uterus. With its short operation time and no complication rate, we believe that this method is an enrichment of the laparoscopic hysterectomy techniques.
authors.affiliation: Department of Obstetrics and Gynecology, University of Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany. andreas.kavallaris@uk-sh.de
authors.forename: Andreas
authors.initials: A
authors.lastname: Kavallaris
authors.forename: N
authors.initials: N
authors.lastname: Chalvatzas
authors.forename: K
authors.initials: K
authors.lastname: Kelling
authors.forename: M K
authors.initials: MK
authors.lastname: Bohlmann
authors.forename: K
authors.initials: K
authors.lastname: Diedrich
authors.forename: A
authors.initials: A
authors.lastname: Hornemann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000295:instrumentation* / Q000379:methods; D010535:Laparoscopy / Q000295:instrumentation* / Q000379:methods; D008875:Middle Aged; D016896:Treatment Outcome