LAPAROSCOPY-ASSISTED RADICAL VAGINAL HYSTERECTOMY MODIFIED ACCORDING TO SCHAUTA-STOECKEL

In laparoscopy-assisted radical vaginal hysterectomy, laparoscopy is u sed to develop the paravesical and pararectal spaces. The cardinal Lig ament is isolated and cut after bipolar coagulation to the level of th e deep uterine vein. By the vaginal approach, the ureters are identifi ed before their entry into the bladder pillar. The uterine vessels are pulled down until their laparoscopically coagulated ends become visib le. After incision of the vesicocervical reflection, the uterine fundu s is grasped and developed (Doderlein maneuver). The lower cardinal an d uterosacral ligaments are exposed by pulling the cervix and fundus u teri to the contralateral side. The cardinal and uterosacral ligaments are dissected and ligated, and the specimen is removed. We combined l aparoscopic lymphadenectomy with radical vaginal hysterectomy in 33 wo men with cervical cancer. The mean operating time was 80 minutes for t he vaginal phase and 215 minutes for the laparoscopic phase, including paraaortic and pelvic lymphadenectomy and preparation of the cardinal ligaments. Blood transfusions were necessary in four women. Three pat ients sustained injury to the bladder, one patient to the left ureter, and another patient to the left internal iliac vein. Repair was achie ved at primary surgery for all intraoperative complications. No fistul a was observed. The patients had fully recuperated after a mean of 28 days. The Laparoscopy-assisted Schauta-Stoeckel approach may prove to be a safe alternative to conventional radical abdominal hysterectomy. (Copyright (C) 1996 by The American College of Obstetricians and Gynec ologists.)