Total laparoscopic hysterectomy in women with previous cesarean sections.
OBJECTIVE
To analyze the feasibility and technique of dissecting the urinary bladder from the lower uterine segment during total laparoscopic hysterectomy in women who have previously delivered by cesarean section.


METHODS
Retrospective review (Canadian Task Force classification II-1).


METHODS
Dedicated high-volume gynecologic laparoscopy center.


METHODS
Two hundred sixty-one women who underwent total laparoscopic hysterectomy at our center. There were no exclusion criteria based on the size of the uterus or the number of previous cesarean section deliveries.


METHODS
All patients underwent total laparoscopic hysterectomy and lateral dissection of the bladder.


RESULTS
Of the study cohort, 52% had undergone 1 cesarean section, 42% had undergone 2 cesarean sections, and 6% had undergone 3 caesarean sections. Median (range) clinical size of the uterus was 12 (6-30) weeks; weight of the specimen was 200 (40-2200) g; total duration of surgery was 80 (30-240) min; and total blood loss was 50 (10-2000) mL.


CONCLUSIONS
Total laparoscopic hysterectomy in patients with previous cesarean section deliveries is technically feasible. It can be performed by experienced surgeons irrespective of the size of the uterus or the number of previous cesarean sections.
Sinha
Rakesh
R
Bombay Endoscopy Academy and Centre for Minimally Invasive Surgery, Beams Hospital, Mumbai, India.
Sundaram
Meenakshi
M
Lakhotia
Smita
S
Hedge
Aparna
A
Kadam
Pratima
P
D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002585:Cesarean Section / Q000009:adverse effects*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy; D008875:Middle Aged; D009929:Organ Size; D012189:Retrospective Studies; D013997:Time Factors; D000267:Tissue Adhesions / Q000150:complications* / Q000601:surgery; D001743:Urinary Bladder / Q000601:surgery; D014599:Uterus / Q000473:pathology / Q000601:surgery