Is There a Role for Micro- Or Mini-Laparoscopy in TLH?
Charles H. Koh, M.D.
After successfully tackling the 1500-g uterus for TLH, it
becomes apparent that the standard laparoscopic instruments may be overkill for the
uncomplicated hysterectomy of a 12-week uterus. We recently completed a mini-laparoscopic
hysterectomy using a 4-mm laparoscope and three 3-mm ports. The essential tool was a 3-mm
bipolar grasper (Everest) that proved more than adequate for the task of desiccating the
ovarian pedicle and uterine arteries. A micro unipolar electrode was used to divide the
desiccated structures. Vaginal vault closure was then performed with continuous 3-0 PDS,
using the KOH Ultramicro needleholder and grasper. A 3-mm suction, irrigation probe was
the other essential instrument.
When a bleeder spews blood on the tip of the scope, the
ability to rapidly regain visualization is vital. With the 10-mm laparoscope, one can
irrigate the scope or rapidly touch clear tissue with enough visibility to stop the
bleeding immediately, prior to desiccation. The 4-mm Rot Lens telescope allows the same
quick recovery, whereas the 2-mm fiberoptic laparoscope does not (and is therefore not
suited for surgeries where bleeding can be suddenly overwhelming). In my view, there is a
future for mini-laparoscopic hysterectomy in indicated cases where there are no adhesions
or endometriosis.