IMR Press / CEOG / Volume 46 / Issue 4 / DOI: 10.12891/ceog4642.2019

Clinical and Experimental Obstetrics & Gynecology (CEOG) is published by IMR Press from Volume 47 Issue 1 (2020). Previous articles were published by another publisher on a subscription basis, and they are hosted by IMR Press on as a courtesy and upon agreement with S.O.G.

Open Access Original Research
A novel retrograde approach for total laparoscopic hysterectomy in patients with severe adhesion in the cul-de-sac
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1 Department of Obstetrics and Gynecology, Shimane University School of Medicine, Izumo, Japan
*Correspondence: (K. NAKAYAMA)
Clin. Exp. Obstet. Gynecol. 2019, 46(4), 565–569;
Published: 10 August 2019

Purpose of Investigation: The purpose of the present study was to establish retrograde-total laparoscopic hysterectomy (TLH) as a treatment option for patients with severe adhesions. Materials and Methods: A retrospective review of two cases of endometriosis that underwent retrograde-TLH at Shimane University Hospital due to complete cul-de-sac obstruction was performed. Retrograde-TLH has three key steps: processing the round ligament, anterior lobe of the broad ligament of the uterus, and ligamentum ovarii proprium, followed by dissection of the ureteral roof, and finally, the dissection of the vaginal wall. Results: Retrograde-TLH was successfully performed in the two patients, without complications. Conclusions: For surgeons experienced in the technique, the retrograde-TLH approach offers several advantages, including the simple and safe dissection of tissue planes as close as possible to the edge of adhesions, avoidance of bladder and rectal injuries, and reduced bleeding, minimizing the possibility of conversion to exploratory laparotomy.

Total laparoscopic hysterectomy
Laparoscopic surgery
Figure 1.
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