A Modified Technique to Simplify TLH with New Developed Uterine Manipulator; Anurach Uterine Manipulator (AUM)
Chamnan Tanprasertkul MD*, Anurach Kulvanitchaiyanunt MD**
Affiliation : * Minimally Invasive Gynecologic Unit, Department of Obstetrics and Gynecology, Thammasat University, Pathumthani, Thailand ** Department of Obstetrics and Gynecology, Pranangklao Hospital, Nonthaburi, Thailand
Objective : Total Laparoscopic hysterectomy (TLH) has became more commonly procedures for gynaecological surgery, but
high incidence of complications and the technical challenges are still problematic among less-experienced surgeons. To
accomplish these difficulties, we developed the new uterine manipulator; Anurach uterine manipulator (AUM ) to simplify
TLH with the modified technique. Our objective was to evaluate the feasibility of the new uterine manipulator, AUM, with the
modified total laparoscopic hysterectomy in an initial cohort of patients.
Material and Method: From October 2007 though September 2008, one hundred cases of hysterectomy were done by
modified technique of TLH using AUM. After installation of AUM, a modified technique of TLH was started by posterior
colpotomy, then extended to anterior colpotomy. The operation was performed using bipolar and harmonic scapel for
coagulation and cutting the vascular pedicles and ligaments. The entire procedure was done laparoscopically and the uterus
was removed vaginally. The vaginal cuff was closed by continuous suture, double layers with PDS material.
Results : Most common indication was symptomatic leiomyoma, the uterine size was 64-620 grams. Mean operation time was
98 + 27.1 minutes. Estimated blood loss was 188 + 87.5 ml. There were no bowel or ureteric injuries, except 2 cases of
bladder injury which had been repaired laparoscopically.
Conclusion : The modified technique using AUM could be the option to simplify TLH, in reducing the complications and
having more favorable operative outcomes.
Keywords : Total laparoscopic hysterectomy, Uterine manipulator
