How can we perform TLH safely in difficult cases?

Kazuko Fujiwara, T. Nagase, K. Ebisawa, Tomonori Hada, Yoshiaki Ota, Hiroyuki Kanao, M. Andou
In: JAPANESE JOURNAL OF GYNECOLOGIC AND OBSTETRIC ENDOSCOPY · 2012 · vol. 28(1) , pp. 448–452 · doi:10.5180/jsgoe.28.448 · W2334322834
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This paper describes techniques for performing total laparoscopic hysterectomy in difficult cases, including myomectomy for cervical myomas and ureteral identification for endometriosis, enabling safe completion in 99% of cases.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 · read from full text ⓘ

The paper addresses how to perform total laparoscopic hysterectomy (TLH) safely in difficult cases, focusing on patients with adhesions related to endometriosis and with anatomical distortion from large or cervical myomas. Using case-based experience, it describes corrective myomectomy to correct distortion in cervical myoma cases, and in endometriosis-related cases emphasizes preventing ureteral injury by initially identifying and isolating the ureter, exposing the ureteral tunnel to track its course, and using a retrograde approach to the vagina when there are cul-de-sac adhesions. The authors report that, with these techniques, simple hysterectomy was completed totally laparoscopically in 99% of cases. This paper is centrally about endometriosis — it specifically discusses preventing ureteral injury during TLH in patients with endometriosis-related adhesions and anatomical distortion.

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Abstract

Total laparoscopic hysterectomy (TLH) may be difficult to complete in patients with adhesions due to endometriosis or anatomical distortions due to large myomas and cervical myomas. Our purpose is to consider methods for completing TLH in these difficult cases by referring to the basics of our standard procedure. In cases of cervical myoma, a myomectomy can correct anatomical distortion and facilitate safer and easier TLH. In cases of endometriosis, ureteral injury can occur due to adhesions and anatomical distortion. To address this, we initially identify and isolate the ureter and expose the ureteral tunnel to track its course. These steps help us overcome difficulties during the procedure, enabling a safe TLH. In addition, in our experience, a retrograde approach to the vagina is useful in cases with cul-de-sac adhesions. With these techniques, it is possible to complete TLH safely even in difficult cases. We were able to complete simple hysterectomy totally laparoscopically in 99% of cases.
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Original article How can we perform TLH safely in difficult cases? 2012 Volume 28 Issue 1 Pages 448-452 Details Abstract Total laparoscopic hysterectomy (TLH) may be difficult to complete in patients with adhesions due to endometriosis or anatomical distortions due to large myomas and cervical myomas. Our purpose is to consider methods for completing TLH in these difficult cases by referring to the basics of our standard procedure. In cases of cervical myoma, a myomectomy can correct anatomical distortion and facilitate safer and easier TLH. In cases of endometriosis, ureteral injury can occur due to adhesions and anatomical distortion. To address this, we initially identify and isolate the ureter and expose the ureteral tunnel to track its course. These steps help us overcome difficulties during the procedure, enabling a safe TLH. In addition, in our experience, a retrograde approach to the vagina is useful in cases with cul-de-sac adhesions. With these techniques, it is possible to complete TLH safely even in difficult cases. We were able to complete simple hysterectomy totally laparoscopically in 99% of cases. © 2012 Japan Society of Gynecologic and Obstetric Endoscopy and Minimally Invasive Therapy Favorites & Alerts Recently viewed articles

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endometriosis

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last seen: 2026-06-04T00:00:01.174412+00:00
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