Hand-Assisted laparoscopic hysterectomy for large uterine fibroids

Background: In recent years, laparoscopic hysterectomy (LH) has increasingly been used in total hysterectomy for uterine fibroids. In our department, approximately 95% of total hysterectomies for benign uterine disease are performed by LH; however, in the 5% patients for whom LH is contraindicated, how to provide minimally invasive surgery was a challenge. Methods: To avoid open surgery with a large vertical midline incision, we introduced a hand-assisted LH (HALH), whereby a lower abdominal transverse incision of 8 cm was made above the pubic symphysis apart from an incision needed for the operating port for laparoscopy. Results: The procedure was performed on five patients between January 2015 and February 2016. The mean weight of the resected uteri was 1382 g, and the mean estimated blood loss was 541 ml. No patients required allogeneic blood transfusion, and there were no complications. Recovery was rapid and postoperative progress was good. Conclusion: HALH is a procedure that avoids traditional open surgery using a large vertical midline incision in patients for whom LH is contraindicated and for those with large uterine fibroids.