title: Total laparoscopic hysterectomy in women with previous cesarean sections.
abstract: 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.
authors.affiliation: Bombay Endoscopy Academy and Centre for Minimally Invasive Surgery, Beams Hospital, Mumbai, India.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Sinha
authors.forename: Meenakshi
authors.initials: M
authors.lastname: Sundaram
authors.forename: Smita
authors.initials: S
authors.lastname: Lakhotia
authors.forename: Aparna
authors.initials: A
authors.lastname: Hedge
authors.forename: Pratima
authors.initials: P
authors.lastname: Kadam
mesh_terms: 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