Single-Port Retroperitoneal Hysterectomy with EnSeal

Introduction: This video shows single-port retroperitoneal hysterectomy (SP-rH) with EnSeal® device. Ligation of the uterine artery is the key procedure of single-port laparoscopic hysterectomy (SP-H). Ureteral injury followed by extensive coagulation of uterine vascular pedicles is one of the most problematic complications in SP-H.1,2 Therefore, ligation of uterine artery at its origin by the retroperitoneal approach can be a good alternative for preventing intraoperative bleeding and ureteral injury.3 Methods: A 49-year-old multiparous woman had a large uterus with adenomyosis, accompanying menorrhagia and dysmenorrhea. She underwent SP-rH at the Samsung Medical Center. Development of the retroperitoneal space and ligation of the uterine artery at its origin where it originates from the internal iliac artery were performed at the first step of SP-rH. We used the commercial single-port platform (LabSingle®; Sejong Medical, Paju, Korea) through a 2.5 cm umbilical incision. To avoid clashing between instruments, a 5-mm 30 degree-angled long laparoscope and articulating instruments (Roticulator® and Endo Shears™; Covidien, Norwalk, CT) were used. Moreover, to get more powerful traction of the uterus, a 5 mm laparoscopic myoma screw was used. An advanced energy device, EnSeal G2 45 mm (Ethicon Endo-Surgery, Blue Ash, OH), was used as a main electrosurgical instrument for dissection, coagulation, and transection of the tissue. Only for the colpotomy procedure, monopolar scissors were used. Vaginal cuff closure was performed using the V-Loc™ suture (Covidien). The uterus was removed with knife morcellation through the vagina. Results: Total operative time was 50 minutes. Time for ligation of bilateral uterine arteries was 4 minutes, 2 minutes each. Time for intracorporeal cuff closure was 6 minutes. Estimated blood loss was 100 mL and uterine weight was 367 g. There was no intra- and postoperative complication. The patient was discharged on postoperative day 3 without any complaints. Conclusion: SP-rH using versatile advanced energy device, EnSeal, is feasible. Multicenter randomized controlled study to evaluate the benefits and safety of SP-rH is ongoing. No competing financial interests exist. Runtime of video: 7 mins 15 secs