Surgical technique and usefulness of Retrograde approach to patients with unclear uterine cevixes and with severe adhesion in a cul-de-sac.

Total laparoscopic hysterectomy (TLH) is becoming a standard minimally invasive procedure for benign pelvic diseases. However, TLH is not usually indicated in cases of large myomas or with severe adhesions in the cul-de-sac, etc., because TLH has been reported to have a higher incidence of injury to adjacent organs such as the ureters than abdominal hysterectomy. Therefore, we have adapted the retrograde hysterectomy, which has been used in abdominal hysterectomy, to TLH.  We performed this procedure for 31 patients with indications in our institution from May 2008 to November 2009 with no complications. As a result, we propose that TLH using a retrograde approach can be safely performed in more severe cases.