Laparoscopic Subtotal Hysterectomy

Laparoscopic subtotal hysterectomy (LSH): LSH refers to the operation of laparoscopic removal of the uterus while retaining the cervix. It has the advantages of short operation time, less intraoperative blood loss, low postoperative morbidity and quick recovery. It is a practical type of surgery at present. Treatment of diseases: uterine fibroids Indication Young people under the age of 35 to 40 years old, the cervix has no lesions, the uterus of the fibroids is generally less than 10 to 12 weeks of uterus size, and there are indications for hysterectomy. Contraindications Contraindications: pelvic malignant lesions (except early onset carcinoma in situ), endometriosis with extensive pelvic adhesions and pelvic inflammatory disease, larger and lower position cervical fibroids, broad ligament fibroids, with larger sum There are adhesive attachment blocks (>6cm diameter), the height of the fundus is higher than the umbilicus, and the vagina is extremely narrow. Preoperative preparation Cervical smear and diagnostic curettage were performed before surgery to exclude cervical and uterine malignant tumors. Surgical procedure The patient took the bladder lithotomy position, placed the catheter, and placed it in the uterus device; the 5 mm and 10 mm puncture holes were made on both sides of the umbilicus and abdominal wall respectively; the uterine round ligament and the fallopian tube and ovarian intrinsic ligament were treated (the pelvis funnel was cut without retaining the ovary) Ligament); open the anterior and posterior lobe of the broad ligament and the bladder reflexes, push down the bladder; treat the uterine blood vessels. Methods for cutting off uterine blood vessels are: Titanium clip method: The uterine artery must be separated before applying the titanium clip. The near-pelvic wall side is close to the upper two titanium nails, a titanium nail on the uterine side, and then the uterine artery is cut; Cutting stapler method: cutting the stapler along the uterus, when the tissue to be cut is inside the forceps, the closed stapler is cut (can also be used for attachment removal); Sewing method: using 2/0 absorbable line, ordinary needle or laparoscope special sled needle to sew through the uterine blood vessels in the uterine isthmus, and knot in the cavity or outside the cavity; Ultrasonic scalpel application method: Ultrasound clips the uterine blood vessels, and the heat generated by ultrasonic vibration is used to coagulate the tissue protein and then cut off. The ultrasonic knife can condense the blood vessels of 5 mm, which can be used in the whole process of surgery. Excision of the uterus: At the uterine isthmus above the uterine blood vessels, the uterus is removed with an electrocoagulation hook or an ultrasonic hook. Cervical stump electrocoagulation to stop bleeding. Remove the palace body: use a cylindrical rotary cutter to pulverize the palace tissue into strips. If there is no cylindrical rotary cutter, the specimen can be taken out after the incision, or a small incision can be made in the abdominal wall to take out the specimen. Rinse the pelvis to stop bleeding and close the puncture hole. complication 1. Bleeding: When dealing with uterine round ligament, ovarian intrinsic ligament, and fallopian tube, the end of the suture is not tight or the knot is slippery and causes bleeding, so double ligation is appropriate. When cutting the uterine arteries and veins, the tissue surrounding the uterine arteries and veins should be separated as much as possible, the blood vessels should be recognized, and the uterus should be clamped tightly and firmly ligated. When pushing down the bladder, it is necessary to distinguish the levels, too shallow or too deep will cause bleeding. 2. Adjacent organ injury: Because subtotal hysterectomy is often used for adhesion between uterus and pelvic organs, especially when the bladder, rectum and cervical adhesions are dense, the anatomical level is not clear, and bladder, rectum and ureteral damage are prone to occur. Once it appears, it should be patched immediately.