Abstract:

During the total laparoscopic hysterectomy (TLH) operation, small changes in the uterine and vaginal cuff position, provided by an adequate manipulator, may optimize the attack angles to the vulnerable structures involved during the procedure and facilitate their dissection. The uterine manipulators are effective because they raise the uterus when moving it from one place to another, leaving the fixing elements on tension. The Lopez-Zepeda uterine manipulator exposes all the anatomic structures involved in TLH, especially those in the vulnerable areas. It avoids dissection and mobilization of the bladder and therefore its innervation. It takes the ureter away from the risky area by 4 cm. to 5 cm. decreasing the injury risk. Finally, thanks to its anteflexion and anteversion movement, it puts the posterior culdotomy area further away from the ureter, the rectum and the sigmoid colon.

Authors:

M.A. López-Zepeda, M.D., Chair Professor, Instituto de Endoscopía Ginecológica S.C., Guadalajara, Jalisco, México, F. Ortiz Morgan, M.D., Diploma Course Program Coordinator, Associated "D" Professor, Coordinación Universitaria of the Hospital Civil de Culiacán, Universidad Autónoma de Sinaloa, Culiacán, Sinaloa, México., Harry Reich, M.D., F.A.C.O.G., Emeritus Staff, Wilkes-Barre General Hospital, Wilkes-Barre, PA

For Direct IP Access please click this link