{"paper_id":"d5920a97-3b60-4d69-9840-4d2311730d41","body_text":"Case Series  \nFeasibility and Outcomes of Laparoscopic Surgery in Complex \nBenign Gynecologic Conditions: A Retrospective Case Series \nSamarina Kamal 1 * , Sweta Lal 2  , Shilpa Tigga 3 , Shikha Rani 1  \n \nSubmitted: 15 Feb. 2026; Accepted: 22 Jun. 2026; Published: 24 Jun. 2026     \nIntroduction \nMinimally invasive surgery has fundamentally transformed the field of gynecology over the past \nthree decades [1]. Since the first laparoscopic hysterectomy was reported by Reich et al., laparo-\nscopic techniques have increasingly replaced conventional open procedures for the management \nof benign gynecological diseases due to their well-documented advantages, including reduced in-\ntraoperative blood loss, shorter hospital stay, faster recovery, decreased postoperative pain, and \nimproved cosmetic outcomes [2]. \nDespite these advantages, the adoption of laparoscopic surgery for complex gynecological \nconditions—such as large uterine fibroids, severe endometriosis with dense adhesions, previous \nmultiple abdominal surgeries, and adnexal masses—remains challenging [3]. Technical difficulty, \ndistorted anatomy, limited access to advanced energy devices, and concerns regarding specimen \n \n1*. Corresponding author: Department of Obstetrics and Gynaecology, MGM Medical College, Jamshedpur, Jharkhand, \nIndia; Kolhan University; Email: drsamrinakamal@gmail.com 2. Department of Obstetrics and Gynaecology, SBMCH, \nHazaribag, Jharkhand, India; Vinoba Bhave University; 3. Department of Obstetrics and Gynaecology, Sadar Hospital, \nRanchi, Jharkhand, India. / Open Access. © 2026 the author(s), published by InfoPub.  This work is licensed under the \nCreative Commons Attribution 4.0 International  License. (Journal homepage: https://www.simmr.info) \nhttps://doi.org/10.66224/smmr.202602.11.01  \nAbstract  \nMinimally invasive surgery has become the preferred approach for benign gynecological conditions due \nto its well -established benefits over open surgery. However, its application in complex cases such as \nlarge uteri, dense adhesions, and advanced adnexal pa thology remains challenging, particularly in re-\nsource-limited settings. We present a retrospective case series of nine patients undergoing laparoscopic \nmanagement for various complex benign gynecological conditions in a single surgical center. Cases in-\ncluded large fibroid uterus, adenomyosis, endometriosis with dense adhesions, dermoid and ovarian \ncysts, post-hysterectomy adnexal mass, umbilical port hernia, and ruptured ectopic pregnancy. Surgical \noutcomes including operative time, blood loss, hemoglobin c hange, hospital stay, and complications \nwere analyzed descriptively. All procedures were successfully completed laparoscopically without con-\nversion to open surgery. Operative time ranged from 35 to 90 minutes. Estimated blood loss was mini-\nmal with no major  intraoperative complications such as bowel, bladder, or vascular injury. Postopera-\ntive recovery was uneventful in most cases, with hospital stay ranging from 1 to 3 days. One case of port-\nsite infection and delayed wound healing was noted in a dermoid cys t case. Laparoscopic surgery is \nfeasible and safe even in complex benign gynecological conditions when performed by experienced sur-\ngeons. With appropriate technical modifications, minimally invasive approaches can be extended to \ncases traditionally managed by laparotomy, even in resource-limited settings. \nKeywords\n : Gynecologic Laparoscopy; Uterine Fibroid; Endometriosis; Ovarian Cyst; Ectopic \nPregnancy. \n \n \nStudies in \nMultidisciplinary Medical Research Published By InfoPub \n\n\n \n  \nSMMR Journal ǁ (2026) NO 11; VOL 02: 01-10 ǁ ǁ https://doi.org/10.66224/smmr.202602.11.01 ǁ InfoPub \nhttps://doi.org/10.32592/smmr.202501.02.02 \nwww.simmr.info \nretrieval in the absence of morcellation continue to restrict its widespread application, particu-\nlarly in resource-constrained healthcare settings [4]. \nIn high-resource environments, advanced laparoscopic techniques and energy devices have \nenabled surgeons to extend minimally invasive approaches even to large uteri and advanced pel-\nvic pathology [5]. However, in many developing and semi-urban settings, cost constraints, limited \navailability of morcellators, and lack of extensive preoperative imaging or oncologic workup ne-\ncessitate alternative surgical strategies while maintaining safety and outcomes [5, 6]. \nSpecimen retrieval remains one of the most critical challenges in laparoscopic hysterectomy \nfor large uteri. Various techniques such as vaginal morcellation, intracorporeal bisection, and \npiecemeal extraction have been described as safe alternatives when p ower morcellation is not \navailable or not preferred due to concerns regarding occult malignancy dissemination [7, 8]. \nIn this context, we present a retrospective case series of nine patients with complex benign \ngynecological conditions managed laparoscopically in a resource -limited setting. The aim of this \nstudy is to evaluate the feasibility, safety, and practical adaptability of minimally invasive surgical \ntechniques in challenging cases that would traditionally require open laparotomy. \nLiterature review  \nOver the last two decades, the literature has progressively reframed laparoscopic surgery —par-\nticularly total laparoscopic hysterectomy (TLH)—as a viable approach for benign gynecologic dis-\nease even when operative complexity is increased by uterine enlargement, fibroid burden, adhe-\nsions, or challenging anatomy. Early landmark series established proof -of-feasibility for TLH in \n“very enlarged” uteri and helped shift the field away from uterine size as an absolute contraindi-\ncation to minimally invasive surgery [9, 10]. As experience increased, subsequent work broad-\nened the size thresholds examined (for example, uteri exceeding 500 g and later those exceeding \n1 kg), while refining the operative strategies used to maintain safety and efficiency in these diffi-\ncult cases [11, 12]. \nHigh-volume, technique-forward studies have been influential in describing how surgeons \novercome the constraints imposed by large fibroid uteri. Sinha and colleagues reported a large \nretrospective experience of TLH for uteri weighing more than 500 g, emphasizing structured tech-\nnical modifications—such as early uterine artery control, selective intraoperative debulking (my-\nomectomy), and planned specimen morcellation—to preserve visualization and reduce bleeding \nrisk across a wide range of uterine sizes [11]. In a later series focused on uteri larger than 16 \nweeks, the same group further characterized perioperative outcomes and highlighted that exten-\nsive adhesiolysis and debulking are frequently required in large -uterus laparoscopy, underscor-\ning that “size” often represents a proxy for distorted anatomy rather than a stand-alone determi-\nnant of difficulty [7]. Complementing these experiences, Roman et al. described TLH for enlarged \nbenign uteri using primary uterine artery coagulation at its origin, reinforcing the concept that \nearly devascularization can facilitate safer dissection in enlarged uteri and may m itigate the ex-\npected relationship between uterine size and operative difficulty in selected settings [13]. \nSeveral comparative and risk -focused studies have attempted to quantify how uterine en-\nlargement affects conversion, operative time, and perioperative morbidity. Takamatsu et al. strat-\nified TLH outcomes by uterine weight and found that cases exceeding 500 g were associated with \nlonger operative times and increased blood loss relative to smaller uteri, alongside a higher rate \nof conversion to laparotomy in the larger group —illustrating that feasibility is maintained but \nwith measurable increases in technical burden [11]. In contrast, Yakıştıran et al. compared TLH \nfor clinically large fibroid uteri (>14 weeks) with TLH for smaller benign uteri and reported \n\n \n  \nSMMR Journal ǁ (2026) NO 11; VOL 02: 01-10 ǁ ǁ https://doi.org/10.66224/smmr.202602.11.01 ǁ InfoPub \nhttps://doi.org/10.32592/smmr.202501.02.02 \nwww.simmr.info \nbroadly similar perioperative outcomes between groups, while still documenting that conver-\nsions occurred and were typically driven by bleeding, impaired uterine mobilization, or bowel \ninjury—mechanisms that resonate with the practical challenges of large fibroid surgery [14]. Im-\nportantly, Cianci et al. examined conversion risk in an enlarged -fibroid cohort and reported that \nconversion was more strongly associated with the diameter of the largest fibroid and the sur-\ngeon’s experience than with uterine weight alone, supporting the contemporary view that uterine \nconfiguration and operator factors may outperform weight-based thresholds as predictors of dif-\nficulty [15]. \nA parallel body of evidence has focused specifically on very large (“giant”) uteri, commonly \ndefined as ≥1 kg or even ≥1.5 kg, and has expanded feasibility claims into more extreme size \nranges while introducing more robust comparisons with open hysterectom y. Kondo and col-\nleagues directly addressed whether laparoscopic hysterectomy is feasible for uteri larger than \n1,000 g, helping anchor the “giant uterus” category in the minimally invasive literature [12]. Uc-\ncella and collaborators subsequently reported dedicated experience with laparoscopic hysterec-\ntomy for uteri ≥1 kg and later extended this work to comparative analyses in uteri >1 kg, position-\ning laparoscopy as a reasonable alternative to laparotomy in appropriately selected benign dis-\nease even at very high uterine weights [16, 17]. Ito et al. similarly evaluated minimally invasive \nhysterectomy in uteri >1 kg and documented that conversions still occur in a minority of cases, \ncommonly due to hemorrhage or adhesions, thereby reinforcing that technical feasibility at ex-\ntreme size remains contingent on intraoperative conditions rather than size alone [18]. More re-\ncently, Fitzgerald et al. compared laparoscopic versus open hysterectomy for benign indications \nin a large cohort of patients with uteri >1 kg and reported broadly comparable adjusted composite \nperioperative outcomes between routes, contributing contemporary support that laparoscopy is \nnot necessarily associated with higher overall perioperative risk even in very large uteri when \nperformed in experienced systems [19]. Collectively, these studies indicate that while uterine en-\nlargement increases operative complexity and may lengthen operating time, minimally invasive \napproaches can maintain acceptable safety profiles in expert hands, with conversion risk shaped \nby hemorrhage, adhesions, and anatomic distortion as much as by uterine weight [14, 15, 18]. \nBeyond hysterectomy itself, the literature also emphasizes that operative success in complex \nbenign gynecology depends on technical adaptations for specimen handling and extraction, par-\nticularly when tissue bulk or cyst content spillage introduces contamination risk. Wang et al. com-\npared different approaches to removing large uteri in TLH (transvaginal extraction versus mor-\ncellation-based strategies), illustrating that extraction strategy can influence operative efficiency \nand intraoperative event profiles even when global outcomes such as blood loss and hospital stay \nremain similar [20]. Similarly, Oh et al. evaluated transumbilical versus transvaginal morcellation \nin single-port TLH for uteri ≥500 g, highlighting that multiple extraction routes may be feasible \nwhen matched to anatomy and surgeon preference [21]. In anatomically demanding subgroups, \nTaniguchi et al. focused on large cervical fibroids (≥10 cm) and demonstrated completion of TLH \nusing planned debulking strategies when standard progression was limited, reflecting a broader \ntheme across the literature: complexity is frequently overcome by stepwise modifications rather \nthan by abandoning laparoscopy [22]. \nStudy Design and Methodology  \nThis study is a retrospective case series evaluating the feasibility, technical challenges, and peri-\noperative outcomes of laparoscopic management in complex benign gynecological conditions. \n \n\n \n  \nSMMR Journal ǁ (2026) NO 11; VOL 02: 01-10 ǁ ǁ https://doi.org/10.66224/smmr.202602.11.01 ǁ InfoPub \nhttps://doi.org/10.32592/smmr.202501.02.02 \nwww.simmr.info \nSetting and Surgeon \nAll procedures were performed by a single experienced laparoscopic gynecologist in a re-\nsource-limited surgical setting. \nPatient Selection \nNine consecutive patients with various benign gynecological pathologies requiring surgical \nintervention were included. Indications included large uterine fibroids, adenomyosis, endometri-\nosis with dense adhesions, adnexal masses, post-hysterectomy ovarian cyst, umbilical port hernia, \nand ruptured ectopic pregnancy. \nSurgical Technique \nAll surgeries were performed under general anesthesia with endotracheal intubation. Pneu-\nmoperitoneum was established using a Veress needle. A standard three - or four-port technique \nwas used. A 10 mm umbilical primary port was inserted at or above the umbilical level depending \non uterine size. Two 5 mm accessory ports were placed in the right and left iliac fossae for opera-\ntive instruments including harmonic scalpel, graspers, and suction devic es. A suprapubic 5 mm \nport was used for uterine manipulation when required. \nA systematic abdominal survey was performed prior to procedure -specific intervention. Pa-\ntients were placed in Trendelenburg position to facilitate bowel displacement and pelvic expo-\nsure. Adhesiolysis, cystectomy, salpingo-oophorectomy, hysterectomy, or ectopic pregnancy man-\nagement was performed depending on pathology. Specimen retrieval was performed via the vag-\ninal route or through enlarged port sites. Morcellation devices were not used in any case. Alterna-\ntive techniques such as vaginal myomectomy, uterine bisection, or piecemeal extraction were \nadopted when required. Hemostasis was ensured at the end of each procedure. A drain was placed \nthrough a 5 mm port in selected cases. Postoperative management included early ambulation, oral \nintake after bowel activity, and prophylactic antibiotics for three days in selected patients. \nResults  \nOverall Outcomes \nAll nine procedures were completed laparoscopically without conversion to open surgery. No \nmajor intraoperative complications such as bowel, bladder, or vascular injury were observed. Op-\nerative outcomes are summarized in Table 1 and Table 2. \nTable 1. Patient age, symptoms, past surgical history, duration of hospitalization and postoperative analysis \nCases  Age Symptoms  Past Surgical History  Days of \nhospitalization  \nUse of post-\noperative analgesia \n \n \n \n1 48 Metrorrhagia Previous 2 LSCS 3 2 days, NSAIDS \n2 38 Severe dysmenorrhoea - 3 2 days, NSAIDS \n3 42 Chronic pelvic pain & severe \ndysmenorrhoea - 3 2 days, NSAIDS \n4 48 Menorrhagia - 3 2 days, NSAIDS \n5 48 Right sided lower abdominal \npain \nTotal abdominal \nhysterectomy  2 1 day, NSAIDS \n6 52  left sided iliolumbar \nmass(para umbilical) LAVH 3 2 days, NSAIDS \n7 28 Right sided pain abdomen  - 1 1 day, NSAIDS \n8 24 Right sided pain abdomen Previous 1 LSCS 1 1 day, NSAIDS \n9 26 Dizziness,acute pain abdomen  Previous \nappendicectomy  2 2 days, NSAIDS \n\n \n  \nSMMR Journal ǁ (2026) NO 11; VOL 02: 01-10 ǁ ǁ https://doi.org/10.66224/smmr.202602.11.01 ǁ InfoPub \nhttps://doi.org/10.32592/smmr.202501.02.02 \nwww.simmr.info \nTable 2.  Description of pathology, method of retrieval of specimen, duration of Surgery, Blood Loss, \nHistopathological Diagnosis \nCases  Pathology  \nmethod of \nretrieval of \nspecimen   \nDuration \nof surgery  \nBlood loss  \nHistopathological \ndiagnosis \n \n \n Preop \nHb(gm) \nPostop \nHb(gm) \n1 \n14 weeks size uterus \nmultiple fibroids– \nlargest 5x6cm \nVaginally after \nvaginal \nmyomectomy  \n1hr 30 mts 9  8.2 Fibroid  \n2 20 weeks size \nadenomyotic uterus  Vaginally  1 hr 45 \nmts 10 9.2 Adenomyosis  \n3 Chronic PID + \nchocolate cyst Vaginally  1 hr 38 \nmts 10.2 9.2 Endometriosis \n4 20 weeks uterus + \nadnexal lump \nVaginally after \novarian cyst \nsuctioning  \n1 hr 34 \nmts 9.8 9.0 Cystadenoma \n5 Post hysterectomy \novarian cyst \nThrough right \nsided port \nincision \n45 mts 10.4 10.0 Simple ovarian cyst  \n6 Umbilical port hernia - 1 hr 30 \nmts 10.8 10.0  \n7 Dermoid cyst 6.8 \nx6cm \nThrough right \nsided port 35 mts 11.2 10.4 Mature cystic \nteratoma \n8 Dermoid cyst 6 x7cm Through right \nsided port  45 mts 12 11.2 Mature cystic \nteratoma  \n9 \nRuptured left sided \ntubal ectopic with \ngross \nhaemoperitoneum \nThrough left \nsided port 56 mts 8 \n11(after 2 \npacked cell \ntransfusion \nTubal ectopic  \nCase Series Description \nUterine Pathology Cases \nThe first group included patients undergoing laparoscopic hysterectomy for large fibroid \nuterus and adenomyosis.  In a 48 -year-old multiparous woman with a 14 -week-sized fibroid \nuterus and previous two cesarean sections, dense bladder adhesions were encountered intraoper-\natively. Adhesiolysis was performed using harmonic scalpel. Due to the absence of morcellation, \nuterine volume reduction was achieved via vaginal myomectomy prior to extraction (Table 2, Case \n1). A second case involved a 38 -year-old nulliparous woman with a 20 -week-sized adenomyotic \nuterus. Vaginal extraction was not feasible due to narrow introitus; therefore, uterine bisection \nand piecemeal retrieval were performed (Table 2, Case 2, Figure 1). \n \nFigure 1. Large adenomyotic uterus (20-week size) before piecemeal extraction. \n\n\n \n  \nSMMR Journal ǁ (2026) NO 11; VOL 02: 01-10 ǁ ǁ https://doi.org/10.66224/smmr.202602.11.01 ǁ InfoPub \nhttps://doi.org/10.32592/smmr.202501.02.02 \nwww.simmr.info \nA third case demonstrated severe endometriosis with bilateral ovarian endometriomas and \ndense pelvic adhesions. Intraoperative rupture of endometriotic cyst occurred during adhesioly-\nsis, releasing thick chocolate fluid. Extensive adhesiolysis was required before completion of hys-\nterectomy (Figure 2 A&B). \n \nFigure 2. A with dense omental and gut adhesions. B. with adenomyosis and endometriotic tissue. \nAdnexal and Ovarian Pathology \nA 48-year-old patient with a large uterine enlargement and right adnexal cyst underwent lap-\naroscopic hysterectomy with ovarian cyst aspiration prior to specimen retrieval (Table 2, Case 4, \nFigure 3). \n \nFigure 3. 20 weeks size uterus. \nA post-hysterectomy ovarian cyst case was managed laparoscopically with adhesiolysis and \nadnexal excision through a port site (Table 2, Case 5, Figure 4). \n \nFigure 4. Ovarian cyst. \n\n\n \n  \nSMMR Journal ǁ (2026) NO 11; VOL 02: 01-10 ǁ ǁ https://doi.org/10.66224/smmr.202602.11.01 ǁ InfoPub \nhttps://doi.org/10.32592/smmr.202501.02.02 \nwww.simmr.info \nDermoid cyst cases (Cases 7 and 8) were managed laparoscopically. In one case, spillage of \nsebaceous material occurred leading to delayed port -site wound healing (Figure 5). In a subse-\nquent similar case, use of an endobag prevented contamination and no pos toperative infection \noccurred. \n \nFigure 5. Depicting right sided dermoid in patient. \nEmergency and Special Cases \nA ruptured tubal ectopic pregnancy with hemoperitoneum was successfully managed via lap-\naroscopic salpingectomy. Blood was evacuated and patient stabilized postoperatively (Table 2, \nCase 9, Figure 6). Umbilical port hernia repair was also performed laparoscopically (Case 6). \n \nFigure 6. Rupture ectopic. \nDiscussion \nIn this case series of nine complex benign gynecologic conditions, laparoscopic management was \nfeasible across a heterogeneous spectrum including large fibroid and adenomyotic uteri, severe \nendometriosis with dense adhesions, adnexal pathology (including d ermoid cyst), port-site her-\nnia, and ruptured ectopic pregnancy. All procedures were completed laparoscopically without \nconversion to laparotomy, operative time ranged from approximately 35 to 105 minutes, and no \nmajor intraoperative complications such as bowel, bladder, or major vascular injury were encoun-\ntered. Postoperative outcomes were generally favorable with short hospitalization (1–3 days) and \nuncomplicated recovery in most patients. \n\n\n \n  \nSMMR Journal ǁ (2026) NO 11; VOL 02: 01-10 ǁ ǁ https://doi.org/10.66224/smmr.202602.11.01 ǁ InfoPub \nhttps://doi.org/10.32592/smmr.202501.02.02 \nwww.simmr.info \nOur findings are consistent with the broader minimally invasive gynecology literature demon-\nstrating that procedural difficulty is influenced not only by uterine size but also by case configu-\nration, adhesions, and surgeon experience. Large-uterus hysterectomy series have shown that to-\ntal laparoscopic hysterectomy can be performed even at high uterine weights when enabling \nstrategies such as early devascularization, debulking, and tailored specimen extraction are used \n[7, 11]. However, conversion to open surgery is not uniformly eliminated in larger cohorts, with \nconversions commonly attributed to hemorrhage, extensive adhesions, or inability to progress \n[14, 18]. Predictive analyses further emphasize that the diameter and location of dominant fi-\nbroids and surgeon experience may be more informative than uterine weight alone for anticipat-\ning conversion risk [15]. In this context, our zero-conversion rate likely reflects careful intraoper-\native strategy and operator proficiency, while the small sample size limits inference about ex-\npected conversion rates in broader practice. \nA notable event in our series was postoperative port -site infection following dermoid cyst \nspillage. In a subsequent case, the use of an endobag prevented contamination and was associated \nwith uneventful recovery. Although most comparative studies focus on  large uterus extraction \ntechniques rather than dermoid cysts specifically, multiple reports underscore the importance of \nspecimen extraction strategy as a modifiable technical element in complex laparoscopy [20, 21]. \nOur experience supports routine consideration of containment techniques when managing cystic \nlesions at risk for intraperitoneal spillage. \nThis study has limitations typical of small case series, including limited power to estimate \ncomplication rates, heterogeneity in diagnoses and procedures, and lack of a comparator group. \nFuture work would benefit from standardized reporting of complexity drivers (e.g., adhesions, \ndominant lesion size, prior surgery), intraoperative blood loss, and longer follow -up, ideally \nthrough prospective registries. Nonetheless, our results add pragmatic evidence that complex be-\nnign gynecologic conditions can be managed laparoscopically with acceptable perioperative out-\ncomes when performed by experienced surgeons using appropriate technical modifications, in-\ncluding specimen containment strategies. \nConclusion \nThis retrospective case series demonstrates that laparoscopic management of complex benign gy-\nnecological conditions is feasible and can be performed with favorable perioperative outcomes in \nappropriately selected patients. All nine procedures were successfully completed laparoscopically \nwithout conversion to laparotomy, with no major intraoperative complications and a short post-\noperative hospital stay of 1 –3 days. The study highlights the importance of surgeon experience, \ncareful patient selection, individualized surgical planning, appropriate adhesiolysis and debulking \ntechniques, and safe specimen retrieval strategies. However, given the small sample size, hetero-\ngeneous pathology, retrospective design, and absence of a comparator group, these findings \nshould be interpreted cautiously. Larger prospective studies are required to further establish the \nsafety, reproducibility, and generalizability of laparoscopic approaches in complex benign gyne-\ncological surgery. \nAbbreviations \nTLH: Total Laparoscopic Hysterectomy; LAVH: Laparoscopic -Assisted Vaginal Hysterectomy; \nPID: Pelvic Inflammatory Disease; LSCS: Lower Segment Caesarean Section; NSAIDs: Non-Steroi-\ndal Anti-Inflammatory Drugs; Hb: Hemoglobin. \n \n\n \n  \nSMMR Journal ǁ (2026) NO 11; VOL 02: 01-10 ǁ ǁ https://doi.org/10.66224/smmr.202602.11.01 ǁ InfoPub \nhttps://doi.org/10.32592/smmr.202501.02.02 \nwww.simmr.info \nEthical Approval  \nEthical approval was not required for this study, as it was a retrospective case series involving the \nreview of existing clinical data and did not involve any prospective intervention or alteration in \npatient management. The authors confirm that the study was conducted in accordance with the \nethical principles of the Declaration of Helsinki and all applicable institutional ethical standards. \nThe Institutional/University authorities at MGM Medical College, Jamshedpur, Jharkhand, India \n(Kolhan University), the institution affiliated with the first author, confirmed that formal ethical \ncommittee approval and an ethics approval number were not required for this retrospective case \nseries. \nClinical Trial Number \nNot applicable. This study was a retrospective case series and did not involve prospective clinical \ntrial registration.  \nAvailability of Data and Materials \nThe data supporting the findings of this study are available from the corresponding author upon \nreasonable request, subject to institutional policies and protection of patient confidentiality. \nFunding \nNo specific funding was received for this study. \nAuthors’Contribution  \nSK: Conceptualization, study design, data collection, surgical management, and manuscript prep-\naration. SL: Data interpretation, literature review, and manuscript revision. ST: Data collection, \nclinical input, and manuscript revision. SR: Supervision, clinical oversight, and critical revision of \nthe manuscript. All authors reviewed and approved the final manuscript. \nAcknowledgment  \nThe authors would like to acknowledge the surgical, nursing, anesthesia, and supporting staff in-\nvolved in the care and management of the patients included in this study. \nConsent for Publication  \nWritten informed consent for publication of anonymized clinical information was obtained from \nthe patients included in the study, where applicable. \nCompeting Interests \nThe authors declare that they have no competing interests. \nReferences \n[1]. Wu T, Nie K, Gao Y, Chen Y, Yan J, Wang S, et al. Research Trends and Hotspots in Minimally Invasive \nGynecologic Surgery: A Bibliometric and Visualization Analysis. International journal of women's health. \n2025;17:3331-45 . https://doi.org/10.2147/ijwh.s522821  \n[2]. Buderath P, Kimmig R, Dominowski L, Mach P. Hysterectomy in benign conditions: a 20-year single-center \nretrospective on the development of surgical techniques. 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Published by InfoPub Press. \nPublisher Homepage: https://www.infopubpress.com/  \n \nDisclaimer: The views, opinions, and data presented in this article are solely those of the author(s) and do not necessarily \nreflect the official policy or position of Infopub Press.","source_license":"CC0","license_restricted":false}