LAparoscopic Supracervical Hysterectomy (LASH)

Indication

  • Benign gynecological conditions
    • Uterine fibroids causing serious symptoms (with exception of small, singular intracavitary fibroids FIGO I or II).
    • High suspicion of adenomyosis uteri interna resistant to endocrine therapy.
    • Dysfunctional uterine bleeding resistant to endocrine therapy or endometrial ablation.
  • Urogynecological conditions

Technique

  • Preoperative antibiotic prophylaxis (single shot, second generation cephalosporine).
  • Patient in lithotomy position.
  • Desinfection of the abdomen, thighs, vulva and vagina.
  • Sterile surgical drapes.
  • Urinary catheter.
  • Examination under anesthesia.
  • Grasp the cervix with bullet forceps and uterine sound. We suggest the use of an atraumatic uterine manipulator. In the setting of lower resources, one may use the bullet forceps and the uterine sound held together as a manipulator. Performing LASH without a manipulator is also possible, however not as safe.
  • Change of surgical gloves, start of laparoscopy.
  • Placement of a drainage.
  • Removal of instruments and trocars under direct visualization.
  • Suturing of the skin.

Contraindications

  • Patient not fit for surgery.
  • Patient has further plans for bearing children.

Complications

  • Injury of nearby organs (ureter, bladder, bowel).
  • Bleeding.
  • Thromboembolism.
  • Infection.
  • Dissemination of benign condition or malignancy.

Postoperative Management

  • Removal of bladder catheter within the first 24 hours.
  • Removal of drainage on 1st postoperative day.
  • Routine blood test on 1st postoperative day (Hemoglobin).
  • Early patient discharge (usually 3-4 days).
  • Venous thromboembolism prophylaxis with low molecular weight heparin for 7 days.

Bibliography

  • Neis, K. J., Zubke, W., Fehr, M., Römer, T., Tamussino, K., & Nothacker, M. (2016). Hysterectomy for Benign Uterine Disease. Deutsches Arzteblatt international113(14), 242–249. https://doi.org/10.3238/arztebl.2016.0242
  • Sandberg, E. M., Hehenkamp, W., Geomini, P. M., Janssen, P. F., Jansen, F. W., & Twijnstra, A. (2017). Laparoscopic hysterectomy for benign indications: clinical practice guideline. Archives of gynecology and obstetrics296(3), 597–606. https://doi.org/10.1007/s00404-017-4467-9
  • Encke, A., Haas, S., & Kopp, I. (2016). The Prophylaxis of Venous Thromboembolism. Deutsches Arzteblatt international113(31-32), 532–538. https://doi.org/10.3238/arztebl.2016.0532

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