Utility of an Internal Retractor (EndoGrab) for the Management of the Vesicouterine Ligament during Laparoscopic Radical Hysterectomy

作者：Kobayashi Eiji^*; Kakuda Mamoru; Tanaka Yusuke; Morimoto Akiko; Egawa Takata Tomomi; Matsuzaki Shinya; Ueda Yutaka; Yoshino Kiyoshi; Kimura Tadashi

来源：Gynecologic and Obstetric Investigation, 2016, 81(4): 363-366.

DOI：10.1159/000443392

• Laparoscopic radical hysterectomy
• Urologic injury
• Vesicouterine ligament
• Internal retractor
• EndoGrab

Background/Aims: The study aims to prevent serious urologic injury during a radical hysterectomy; we propose that one of the most important procedural steps is the careful management of the vesicouterine ligament (VUL). Patients and Methods: Between January 2013 and October 2014, we used a novel internal retractor in 17 patients undergoing a laparoscopic radical hysterectomy (LRH) for early-stage cervical cancer to obtain and secure a better surgical view. For management of the VUL during the laparoscopic procedure, we routinely used an internal retractor (EndoGrab; Virtual Ports, Misgav, Israel) and vessel tape to reposition the ureter in a safe lateral-caudal direction. Results: Using an EndoGrab, we were easily able to reproduce a suitable surgical view that simulated the one obtained by an abdominal route for radical hysterectomy. Using this improved laparoscopic procedure, we completed radical hysterectomies in all 17 cases without a ureteral injury complication. Conclusion: Our modified method using an EndoGrab is effective for the prevention of ureteral injury during a LRH, and its ease of use makes it suitable even for those surgeons early in their laparoscopic learning curve.

• 出版日期2016