Laparoscopic Hysterectomy Tips & Tricks

The episode begins with Mark describing his journey to becoming a minimally invasive gynecologic surgeon, with more exposure to traditional laparoscopic surgery (“straight stick”) throughout his career, but with a recent revival of robotic surgery as well. Overall, Mark still prefers traditional laparoscopy. However, there are certain instances where robotics is especially helpful – namely in patients with a high BMI and in myomectomies where robots make the extensive suturing more manageable. Additionally, robotic surgery is easier to do in a situation where students and residents are not available to assist. Most importantly, he likes to get an MRI, look at the anatomy, and decide what the best approach is for each individual patient. And of course, the doctors emphasize the importance of having a strong team to operate with.

Next, Mark discusses his tips and tricks to a successful laparoscopic hysterectomy. He likes to be in the operating room before the patient is there to ensure it is set up correctly. Once the patient arrives, he stresses the importance of proper patient positioning on the bed, with the arms always tucked at the patient’s side, and then inserting the Foley catheter after draping. The doctors then discuss incision locations and sizes, with Mark preferring all 5 cm incisions. Mark continues with the steps of the procedure – he starts with the fallopian tubes, then gets the utero-ovarians and carries around the round ligament to move the ovaries laterally. He then emphasizes skeletonizing the uterines/posterior peritoneum. He saves the anterior incisions for last as they can get complicated with adhesions from prior C-sections, for example. Mark highlights the “critical view,” which is the anterior cup, posterior cup, ring, and vessels on the other side. The doctors go on to discuss colpotomy, barbed sutures, visualization, antibiotics, and more.

The physicians end by expressing the importance of asking for help, knowing your limits as a surgeon, and ensuring patient safety.