title: Two-phase laparoendoscopic single-site cervical ligament-sparing hysterectomy: A novel approach in difficult laparoscopic hysterectomy.
abstract: OBJECTIVE
  To proposed a novel method for a difficult laparoscopic hysterectomy that spares the cervical ligaments and eliminates the cervical canal and transformation zone of the cervix.
  
  
  METHODS
  A 40-year-old women, gravida 3 para 3, who had had a cesarean delivery previously, was referred to the gynecology clinic due to adenomyosis with menorrhagia and severe anemia. Ultrasonography showed that the uterus was enlarged to 13.5 cm × 10.7 cm × 8.8 cm. After obtaining informed consent, a two-phase laparoendoscopic single-site (LESS) cervical ligaments-sparing hysterectomy was performed smoothly. The patient discharged on 4th day and resumed her sexual life less than 2 months after surgery.
  
  
  CONCLUSIONS
  This novel minimal invasive method of hysterectomy makes difficulty laparoscopic hysterectomy easy and safe. Preservation of cervical ligaments retains stability in the pelvic floor and may reduce intraoperative complications and subsequent pelvic floor organ prolapse.
authors.affiliation: Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan, ROC; Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan, ROC.
authors.forename: Mun-Kun
authors.initials: MK
authors.lastname: Hong
authors.affiliation: Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan, ROC; Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan, ROC.
authors.forename: Tang-Yuan
authors.initials: TY
authors.lastname: Chu
authors.affiliation: Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan, ROC; Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan, ROC. Electronic address: dah1003@yahoo.com.tw.
authors.forename: Dah-Ching
authors.initials: DC
authors.lastname: Ding
mesh_terms: D062788:Adenomyosis / Q000150:complications / Q000601:surgery; D000328:Adult; D000740:Anemia / Q000209:etiology; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy; D008022:Ligaments; D008595:Menorrhagia / Q000150:complications / Q000601:surgery; D059351:Organ Sparing Treatments / Q000379:methods*
keywords: difficult laparoscopic hysterectomy; laparoendoscopic single site surgery; large uterus