Single Port Laparoscopic Assisted Hysterectomy

This chapter describes the necessary steps to perform single port laparoscopic hysterectomy. This surgical approach is an innovative method to offer all of the benefits of multi-port laparoscopy through one single incision usually in and around the umbilicus. Using core surgical principles and instruments available for single port surgery external triangulation and full range of motion can be maintained to achieve the required internal manipulation of instruments and tissue dissection. All single port surgeries require a specialized port used along with an angled or flexible laparoscope for visualization. Traditional laparoscopic instruments may be used for the surgical dissection and completion of the procedure

Surgical Site Infection after Hysterectomy

Surgical site infections (SSIs) are associated with increased morbidity, mortality, and healthcare costs. SSIs are defined as an infection that occurs after surgery in the part of the body where the surgery took place. Approximately 1–4% of hysterectomies are complicated by SSIs, with higher rates reported for abdominal hysterectomy. Over the past decade, there has been an increasing number of minimally invasive hysterectomies, in conjunction with a decrease in abdominal hysterectomies. The reasons behind this trend are multifactorial but are mainly rooted in the well-documented advantages of minimally invasive surgery. Multiple studies have demonstrated a marked decrease in morbidity and mortality with minimally invasive surgeries. Specifically, evidence supports lower rates of SSIs after laparoscopic hysterectomy when compared to abdominal hysterectomy. In fact, the American College of Obstetricians and Gynecologist recommends minimally invasive approaches to hysterectomy whenever feasible. This chapter will review the current literature on surgical site infection (SSI) after hysterectomy for benign indications

Vaginal Erosion of an Abdominal Cerclage 7 Years After Laparoscopic Placement

BACKGROUND: With advances in minimally invasive approaches, laparoscopically placed abdominal cerclages are becoming more common. Although not meant to replace vaginally placed cerclages, one potential advantage is reuse in subsequent pregnancies. Their lifespan, potential remote complications, and long-term management remain unexplored. CASE: Reported is a patient with a laparoscopic abdominal cerclage who carried two pregnancies to term. Seven years after initial placement, 3 years after her last delivery, an abscess developed at the cerclage site. Erosion and subsequent expulsion of the cerclage followed. CONCLUSION: The longevity of abdominally placed cerclages is unknown. Placement in the peritoneal cavity reduces suture migration risk, yet tissue degradation may limit the lifespan. Patients with retained abdominal cerclages after completion of childbearing are at risk for remote complications. Closer long-term surveillance on an individual level and a collective level is warranted