title: A modified technique to simplify TLH with new developed uterine manipulator; Anurach uterine manipulator (AUM).
abstract: OBJECTIVE
  Total Laparoscopic hysterectomy (TLH) has became more commonly procedures for gynaecological surgery, but high incidence of complications and the technical challenges are still problematic among less-experienced surgeons. To accomplish these difficulties, we developed the new uterine manipulator; Anurach uterine manipulator (AUM) to simplify TLH with the modified technique. Our objective was to evaluate the feasibility of the new uterine manipulator; AUM, with the modified total laparoscopic hysterectomy in an initial cohort of patients.
  
  
  METHODS
  From October 2007 though September 2008, one hundred cases of hysterectomy were done by modified technique of TLH using A UM. After installation of AUM, a modified technique of TLH was started by posterior colpotomy, then extended to anterior colpotomy. The operation was performed using bipolar and harmonic scapel for coagulation and cutting the vascular pedicles and ligaments. The entire procedure was done laparoscopically and the uterus was removed vaginally. The vaginal cuff was closed by continuous suture, double layers with PDS material.
  
  
  RESULTS
  Most common indication was symptomatic leiomyoma, the uterine size was 64-620 grams. Mean operation time was 98 +/- 27.1 minutes. Estimated blood loss was 188 +/- 87.5 ml. There were no bowel or ureteric injuries, except 2 cases of bladder injury which had been repaired laparoscopically.
  
  
  CONCLUSIONS
  The modified technique using AUM could be the option to simplify TLH, in reducing the complications and having more favorable operative outcomes.
authors.affiliation: Minimally Invasive Gynecologic Unit, Department of Obstetrics and Gynecology, Thammasat University, Pathumthani, Thailand. C.tanprasertkul@gmail.com
authors.forename: Chamnan
authors.initials: C
authors.lastname: Tanprasertkul
authors.forename: Anurach
authors.initials: A
authors.lastname: Kulvanitchaiyanunt
mesh_terms: D000328:Adult; D020884:Colpotomy / Q000295:instrumentation; D004867:Equipment Design; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000295:instrumentation* / Q000379:methods*; D015907:Hysteroscopy / Q000295:instrumentation / Q000379:methods*; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014591:Uterine Diseases / Q000601:surgery*