A Safe and Simple Laparoscopic Cold Knife Section Technique for Bulky Uterus Removal.
BACKGROUND
Morcellation of a bulky uterus after total laparoscopic hysterectomy (TLH) is a challenge for those dealing with advanced laparoscopic surgery. However, there are no laparoscopic standardized procedures available to date. We developed a laparoscopic cold knife technique with the aim of demonstrating a simple and reproducible method of sectioning and vaginal retrieval of the bulky uterus.


METHODS
From June 2012 to June 2014, patients who underwent TLH for benign indication, with a uterus size over 12 gestational weeks, were prospectively admitted into the clinical study. Before specimen vaginal retrieval, uterine section was achieved by Chardonnens' cold knife with the aim of obtaining two uterus halves sectioned longitudinally and held together only by the posterior cervical wall. We performed the procedure in a containment system to avoid myometrial spillage into the abdomen.


RESULTS
Twenty-nine women with a bulky uterus were treated by TLH and the cold knife section technique. The uterine size ranged from 240 to 850 g (median, 460 g), and the average morcellation operative time was 11.3 minutes. All procedures were completed successfully without complications.


CONCLUSIONS
Our data suggest that the cold knife uterine section technique after TLH is a feasible, simple, and reproducible method of bulky uterus morcellation, even if further research is advisable to fully evaluate the advantages of this procedure.
1 Department of Gynecology and Obstetrics, G. Borea Hospital , Sanremo, Italy .
Fabio
F
Montella
2 Department of Gynecology and Obstetrics, University of Torino , S. Anna Hospital, Torino, Italy .
Stefano
S
Cosma
3 Department of Gynecology and Obstetrics, SS. Antonio e Biagio e Cesare Arrigo Hospital , Alessandria, Italy .
Francesca
F
Riboni
3 Department of Gynecology and Obstetrics, SS. Antonio e Biagio e Cesare Arrigo Hospital , Alessandria, Italy .
Davide
D
Dealberti
2 Department of Gynecology and Obstetrics, University of Torino , S. Anna Hospital, Torino, Italy .
Chiara
C
Benedetto
1 Department of Gynecology and Obstetrics, G. Borea Hospital , Sanremo, Italy .
Sergio
S
Abate
D003080:Cold Temperature; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D061646:Operative Time; D016896:Treatment Outcome; D014591:Uterine Diseases / Q000473:pathology / Q000601:surgery*