title: A new approach to simplify surgical colpotomy in laparoscopic hysterectomy.
abstract: New surgical techniques and technology have simplified laparoscopic hysterectomy and have enhanced the safety of this procedure. However, the surgical colpotomy step has not been addressed. This study evaluates the surgical colpotomy step in laparoscopic hysterectomy with respect to difficulty and duration. Furthermore, it proposes an alternative route that may simplify this step in laparoscopic hysterectomy. A structured interview, a prospective cohort study, and a problem analysis were performed regarding experienced difficulty and duration of surgical colpotomy in laparoscopic hysterectomy. Sixteen experts in minimally invasive gynecologic surgery from 12 hospitals participated in the structured interview using a 5-point Likert scale. The colpotomy in LH received the highest scores for complexity (2.8 ± 1.2), compared to AH and VH. Colpotomy in LH was estimated as more difficult than in AH (2.8 vs 1.4,p< .001). In the cohort study, 107 patients undergoing LH were included. Sixteen percent of the total procedure time was spent on colpotomy (SD 7.8 %). BMI was positively correlated with colpotomy time, even after correcting for longer operation time. No relation was found between colpotomy time and blood loss or uterine weight. The surgical colpotomy step in laparoscopic hysterectomy should be simplified as this study demonstrates that it is time consuming and is considered to be more difficult than in other hysterectomy procedures. A vaginal approach to the colpotomy is proposed to achieve this simplification.
authors.affiliation: Department of Gynecology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: van den Haak
authors.affiliation: Department of Obstetrics and Gynecology, Bronovo Hospital The Hague, The Hague, The Netherlands.
authors.forename: J P T
authors.initials: JP
authors.lastname: Rhemrev
authors.affiliation: Department of Gynecology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands.
authors.forename: M D
authors.initials: MD
authors.lastname: Blikkendaal
authors.affiliation: Department of Gynecology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands.
authors.forename: A C M
authors.initials: AC
authors.lastname: Luteijn
authors.affiliation: Department BioMechanical Engineering, Delft University of Technology, 2628 CD Delft, The Netherlands.
authors.forename: J J
authors.initials: JJ
authors.lastname: van den Dobbelsteen
authors.affiliation: Department of Gynecology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands.
authors.forename: S R C
authors.initials: SR
authors.lastname: Driessen
authors.affiliation: Department of Gynecology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands ; Department BioMechanical Engineering, Delft University of Technology, 2628 CD Delft, The Netherlands.
authors.forename: F W
authors.initials: FW
authors.lastname: Jansen
keywords: Colpotomy; Innovation of surgical technique; Laparoscopic hysterectomy; New technology