Laparoscopic Hysterectomy and Prolapse: A Multiprocedural Concept

Background and Objectives: Today, laparoscopic intrafascial hysterectomy and laparoscopic supraceiyical hysterectomy are well-accepted techniques. With our multimodal concept of laparoscopic hysterectomy for benign indications, preservation of the pelvic floor as well as reconstruction of pelvic floor structures and pre-existing prolapse situations can be achieved. Methods: The multimodal concept consists of 3 steps: 1. Intrafascial hysterectomy with preservation of existing structures A. Technique 1: Primary uterine artery ligation B. Technique 2: Classic intrafascial hysterectomy 2. A technique for the stable fixation of the vaginal or cervical stump 3. A new method of pectopexy to correct a pre-existing descensus situation Results and Conclustion: This well-balanced concept can be used by advanced endoscopic gynecologic surgeons as well as by novices in our field.