Speeding The Move To Laparoscopic Hysterectomy
By Charles H. Koh, M.D.
Physician Editor
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the three approaches used to perform hysterectomy - abdominal, vaginal, and laparoscopic -
the last now accounts for the smallest percentage of procedures. This owes to the fact
that many gynecologists proficient at open hysterectomy techniques have balked at adding
the endoscopic approach to their surgical repertoires, perceiving it to be too technically
difficult and time-consuming.
Even
among those gynecologic surgeons who have embraced the laparoscopic approach, the
difficulty of securing the uterine arteries and cardinal ligaments and of performing an
accurate and safe colpotomy at total laparoscopic hysterectomy (TLH) has prompted most to
eschew that operation in favor of laparoscopically assisted vaginal hysterectomy (LAVH).
I believe
all that is about to change, however. Thanks to the arrival of a new generation of
laparoscopic devices, surgeons who master laparoscopic hysterectomy now can perform the
procedure in the same amount of time and at the same cost as that entailed in abdominal
and vaginal hysterectomy.
I
am proud to have contributed to this new generation of devices through my development of
the KOH Colpotomizerä System,
which figures prominently in the straightforward techniques described in the following
articles. When used in conjunction with The RUMI Systemâ Uterine Manipulator (which, like the colpotomizer, is marketed by
CooperSurgical), this device enables the surgeon not only to achieve favorable operative
times and costs, but, more importantly, reduced morbidity and improved outcomes for
patients. As my colleagues' presentations attest, this ability is readily transferable.
In
developing the KOH Colpotomizerä System, I have aimed to simplify laparoscopic hysterectomy, making it
a safe, accurate, efficient, and reproducible technique accessible to all gynecologists.
Together with the RUMI uterine manipulator, the colpotomizer cup and pneumo-occluder
enable the gynecologist to optimally position the uterus during surgery, while also
ensuring maximum exposure of pelvic structures. The cup creates a landmark for locating
the vaginal fomix. By generating traction away from adjacent structures, a substantial
safety zone for accurate colpotomy dissection is created. Following colpotomy, the
inflated pneumo-occluder prevents loss of pneumoperitoneum. As a result of these
innovations, laparoscopic hysterectomy has become an optimal treatment option for women
needing hysterectomies.
On
Sept. 25, 1997, a symposium entitled "Laparoscopic Hysterectomy Simplified: The KOH
Colpotomizer Clinical Experience" was held in Seattle in conjunction with the annual
meeting of the American Association of Gynecologic Laparoscopists. The articles in this
supplement are based on the presentations at that symposium. In the first article, I
discuss the basic technique for using the KOH Colpotomizer. Donald I. Galen, M.D.,
addresses safety issues in the second article, while, in the third, Carl F. Giesler, M.D.,
presents "the Texas Approach' to TLH, explaining how he has managed to reduce
operative time while still achieving good outcomes.
It
is my hope that as we become more familiar and experienced with the new surgical devices
and techniques available, laparoscopic hysterectomy will become the procedure of choice
when hysterectomy is indicated.