Lizard on the wall appearance-total laparoscopic hysterectomy on a ventrofixed uterus
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20250895Keywords:
Cervico-fundal sign (sheth), Lateral window technique, Cytosufflation techniqueAbstract
Hysterectomy is one of the most performed procedures for gynecological conditions worldwide. Ventrofixation of the uterus, a surgical technique where the uterus is fixed to the anterior abdominal wall, can complicate routine gynecological procedures, including hysterectomy. Performing a total laparoscopic hysterectomy (TLH) on a ventrofixed uterus presents unique challenges due to altered anatomy and the presence of adhesive tissues. Adhesions during surgery are associated with increased morbidity due to prolonged operating time and organs injuries. A ventrofixed uterus can often be suspected in patients with a history of CS, based on specific clinical symptoms and ultrasonographic findings described by Sheth et al. Surgeons should be aware of the altered anatomy and the potential for adhesions when performing laparoscopic hysterectomy in such cases. Appropriate preoperative workup and planning of surgery reduces complications and improves the outcome. Some of techniques for dissection of ventrofixed uterus is discussed in this paper.
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References
Bhawna K, Raj TP. Regional Disparities and Determinants of Caesarean Deliveries in India. Indian J Youth & Adol Heal. 2018;7:15-23.
Morales KJ, Gordon MC, Bates GW. Postcesarean delivery adhesions associated with delayed delivery of infant. Am J Obstet Gynecol. 2007;196(5):461-6. DOI: https://doi.org/10.1016/j.ajog.2006.12.017
Bij de Vaate AJ, Brölmann HA, van der Voet LF, van der Slikke JW, Veersema S, Huirne JA. Ultrasound evaluation of the cesarean scar:Relation between a niche and postmenstrual spotting. Ultrasound Obstet Gynecol. 2011;37:93–9. DOI: https://doi.org/10.1002/uog.8864
Sheth SS, Shah NM, Varaiya D. A sonographic and clinical sign to detect specific adhesions following cesarean section. J Gynecol Surg. 2008;24(1):27–36. DOI: https://doi.org/10.1089/gyn.2007.B-02283-1
El-Shawarby SA, Salim R, Lavery S, Saridogan E. Uterine adherence to anterior abdominal. Postcesarean delivery adhesions associated with delayed delivery of infant. Am J Obstet Gynecol. 2007;196(5):461-6.
Sigel B, Golub RM, Loiacono LA. Technique of ultrasonic detec tion and mapping of abdominal wall adhesions. Surg Endosc. 1991;5(4):161–5. DOI: https://doi.org/10.1007/BF02653253
Zinther NB, Zeuten A, Marinovskij E, Haislund M, Friis-Andersen H. Detection of abdominal wall adhesions using visceral slide. Surg Endosc. 2010;24(12):3161–6. DOI: https://doi.org/10.1007/s00464-010-1110-2
Siow A, Nikam YA, Ng C, Su BMC. Urological complications of laparoscopic hysterectomy: four-year review at KK women’s and children’s Hospital, Singapore. Singapore Med J. 2007;48:217-21.