Gradual Vaginal and Perineal Dilation for Atraumatic Transvaginal Uterine Retrieval: Reconsidering Uterine Retrieval Strategies in Minimally Invasive Gynecologic Surgery
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Abstract
Minimally invasive surgery (MIS) is widely performed in gynecology; however, transvaginal uterine retrieval may be complicated by vaginal or perineal lacerations, particularly in cases where uterine fragmentation should be avoided. We describe a practical technique using gradual vaginal and perineal dilation with a Sakurai-type vaginal speculum inserted at the beginning of surgery. This method was applied in three cases (two endometrial cancer and one HSIL/CIN3) in which transvaginal uterine retrieval was anticipated to be technically demanding. In all cases, transvaginal uterine retrieval was completed without vaginal or perineal lacerations requiring suturing, and no prolonged vaginal dilation, increased perineal pain, or abnormal bleeding was observed. Gradual vaginal and perineal dilation combined with careful incision site selection may facilitate safer transvaginal uterine retrieval in MIS.
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References
Lenfant L, Canlorbe G, Belghiti J, Kreaden US, Hebert AE, Nikpayam M, et al. Robotic-assisted benign hysterectomy compared with laparoscopic, vaginal, and open surgery: a systematic review and meta-analysis. J Robot Surg 2023;17:2647-62.
Taniguchi F, Wada-Hiraike O, Hirata T, Tajima H, Masuda H, Kitade M, et al. A nationwide survey on gynecologic endoscopic surgery in Japan, 2014-2016. J Obstet Gynaecol Res 2018;44:2067-76.
Oranratanaphan S, Phoolcharoen N, Ariyasriwatana C, Worasethsin P. A comparative study of quality of life of patients who underwent total laparoscopic hysterectomy and total abdominal hysterectomy. Thai J Obstet Gynaecol 2019;27:63-70.
Chikazawa K, Imai K, Ko H, Ichi N, Misawa M, Kuwata T. Risk factors associated with perineal and vaginal lacerations and vaginal removal in total laparoscopic hysterectomy. Gynecol Minim Invasive Ther 2022;11:150-154.
Kliethermes C, Walsh T, Guan Z, Guan X. Vaginal tissue extraction made easy. J Minim Invasive Gynecol 2017;24:726.
Moawad GN, Samuel D, Abi Khalil ED. Abdominal approaches to tissue containment and extraction in minimally invasive gynecologic surgery. J Minim Invasive Gynecol 2016;23:1032.
Casarin J, Ghezzi F, Dri M, Granato V, Laganà AS, Ambrosoli AL, et al. A Laparoscopic subtotal hysterectomy followed by in-bag transvaginal corpus uteri morcellation and extraction: A case series. Eur J Obstet Gynecol Reprod Biol 2023;282:124-7.
Takeshita R, Aida T, Fukagawa D, Onoue H, Shoji T, Baba T. A technique for vaginal wall protection during transvaginal uterine retrieval in total laparoscopic hysterectomy at our institution. Acta Medica Hachinohe 2019;16:61–5.
Nicolais O, Cummings M, Buchanan TR Jr, Moukarzel L, Cardillo N, Burton E, et al. Vaginal lacerations during laparoscopic hysterectomy for endometrial cancer and local recurrence risk. Gynecol Oncol Rep 2024;54:101433.
Balgobin S, Maldonado PA, Chin K, Schaffer JI, Hamid CA. Safety of manual morcellation after vaginal or laparoscopic-assisted vaginal hysterectomy. J Minim Invasive Gynecol 2016;23:542-7.
Vargas MV, Cohen SL, Fuchs-Weizman N, Wang KC, Manoucheri E, Vitonis AF, et al. Open power morcellation versus contained power morcellation within an insufflated isolation bag: comparison of perioperative outcomes. J Minim Invasive Gynecol 2015;22:433-8.
Kisu I, Bann K, Tokuoka A, Yamaguchi K, Tanaka K, Shiraishi T, et al. Technique for transvaginal removal of large specimen using an Alexis Contained Extraction System during laparoscopic hysterectomy. Obstet Gynecol Sci 2022;65:283-5.
Uckara W, Soimongkol K, Chanasabaeng S, Sutjaritphong P, Weerakiet S. Transvaginal natural orifice transluminal endoscopic surgery for hysterectomy in women with posterior cul-de-sac obliteration: A series of seven cases. Thai J Obstet Gynaecol 2023;31:225-34.
