A SIMPLER APPROACH TO HYSTERECTOMY - ONE-SUTURE LAPAROSCOPIC HYSTERECTOMY

This article describes in detail a new approach to laparoscopic hyster ectomy. It is based on understanding the vasculature of the uterus, ce rvix, and cardinal ligament. The result of this appreciation of the an atomy is a clean, logical, rapid, anatomic approach to hysterectomy no t previously promoted. There is a dissectible, loose, fibrous plane th at lies between the uterus and the portion of the uterine artery that courses up and down the side of the uterus. It is traversed by multipl e small branches of the uterine artery, which are coagulated easily wi th monopolar coagulation current. By the dissection of this plane down the side of the uterus and cervix, the cardinal ligament can be peele d off the cervix. This allows a bloodless dissection well away from an y risk of injury to the ureter. The anatomy and surgical technique are described for laparoscopic hysterectomy and laparoscopically assisted vaginal hysterectomy.