Uterine manipulation is essential for laparoscopic hysterectomy procedures involving dissection of the female pelvis. Several uterine manipulators are available to help maneuver the uterus facilitation proper dissection in the pelvis.
At our World Laparoscopy Hospital, we routinely in female where cervical manipulation is not possible we use the myoma screw for uterine manipulation during total laparoscopic hysterectomy or surgery for cervical, bladder, and rectal cancers.
However, its use is avoided in two situations. First, in endometrial cancer, where the peritoneal spread of tumor cells is feared. Second, in patients with pyometra in cervical cancer, where insertion of the screw would lead to spillage of pus into the abdominal cavity.
With the use of myoma screw, there were no intraoperative complications. In conclusion, this method has the advantages of not requiring any vaginal manipulator, reducing the number of people required during operation, permitting a near-maximum manipulation of the uterus in all three dimensions, and giving the control of these manipulations directly to the surgeon. On the other hand, the technique also has some inadequacies of recognizing vaginal edge which should be discussed and improved on in the future.
Various vaginal manipulators are used in laparoscopic surgery to manipulate the uterus. When these enter through the cancer tissue, like the cervical canal or the endometrial cavity, manipulation can sometimes result in tissue breakup and bleeding. This can theoretically lead to cancer cells entering into the circulation and systemic spread. Some vaginal manipulators are comparatively expensive and require an additional assistant at the vaginal end.
The uterus is often manipulated using a grasping forceps, but this entails the use of one port for uterine manipulation or insertion of an additional port. Moreover, graspers often slip leading to tissue break up. This is especially common at the uterine cornua, which bleed during repeated manipulation with graspers. In all these situations using myoma scew is a good option.
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