Importance:

Hysterectomy is the most common non-pregnancy surgical procedure performed on women. Laparoscopic hysterectomy is a preferable alternative to open abdominal hysterectomy for those patients in whom a vaginal hysterectomy is not feasible. Complex situations that distort the pelvic anatomy make surgery more difficult. There is a need to determine how to do this approach in complex situation.

Objectives:

The aims of this summary are to review the surgical technique for complex situations in laparospic hysterectomy such as fibroids, endometriosis, adhesions and obesity, possible complications, advantages and disadvantages with other approachs in these situations for best clinical practice.

Evidence Acquisition:

We performed a thorough search of PubMed for current literature, including original research articles, review articles, and guidelines on laparoscopic hysterectomy and management in complex situations (large uterus, endometriosis, adhesions and obesity).

Conclusions:

We concluded that laparoscopic hysterectomy is effective and efficient in difficult situations. These should not be considered contraindications to this technique. With good training and an understanding of laparoscopy, it is possible to have a low complications rate and a short-term recovery.

Relevance:

This review is beneficial for all providers caring for women needing laparoscopic hysterectomy with complex situations.

Target Audience:

Obstetricians and gynecologists.

Learning Objectives:

After completing this CME activity, physicians should be able to (1) identify the complex situations for hysterectomy; (2) describe advantages and disadvantages for laparoscopic hysterectomy in these cases; and (3) discuss the possibles changes in surgical technique that allow to perform this approach.

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