Laparoscopic Hysterectomy and Prolapse: A Multiprocedural Concept

ABSTRACT Background and Objectives: Today, laparoscopic intra-fascial hysterectomy and laparoscopic supracervical hyster-ectomy are well-accepted techniques. With our multimodalconcept of laparoscopic hysterectomy for benign indica-tions, preservation of the pelvic floor as well as reconstruc-tion of pelvic floor structures and pre-existing prolapse situ-ations can be achieved. Methods: The multimodal concept consists of 3 steps:1. Intrafascial hysterectomy with preservation of existingstructuresA. Technique 1: Primary uterine artery ligationB. Technique 2: Classic intrafascial hysterectomy2. A technique for the stable fixation of the vaginal orcervical stump3. A new method of pectopexy to correct a pre-existingdescensus situation Results and Conclustion: This well-balanced conceptcan be used by advanced endoscopic gynecologic sur-geons as well as by novices in our field. Key Words: Multimodal concept, Laparoscopy, Hysterec-tomy, Supracervical hysterectomy, Pectopexy. INTRODUCTION Hysterectomy is one of the most frequently performedsurgeries within the discipline of gynecologic surgery.International gynecologic societies recommend vaginalhysterectomy as the most acceptable technique; however,over the past 20 years, operative laparoscopic methodshave gained in standing and they play an increasinglymore important role than the classic approaches of ab-dominal and vaginal hysterectomy.Today, the most frequent indications for hysterectomy aresymptomatic multifibroid uterus, infertility, and therapy-resistant bleeding abnormalities. These constitute up to60% of indications for hysterectomies (or even more).