But a myoma screw could not be used in cases selleck chemical Ganetespib of endometrial cancer or in uterus with pyometra, for risk of spillage of tumor cells or pus into the peritoneal cavity. To obviate the disadvantages of a uterine manipulator, a myoma screw, or a grasping forceps, we adapted a technique which is simple and easy. We have used laparoscopic uterine hitch technique for more than 6 months in 23 such patients. The main advantage of this technique was that the stitch used for manipulation does not go through the tumor tissue. Moreover the operating surgeon could directly control and adjust the retraction to his/her satisfaction (unlike the vaginal manipulation, in which the operating surgeon had to instruct the assistant off and on). This reduced the operative time and stress.

Ample space for dissection in the posterior compartment of the pelvis was created when the uterus was hitched to the anterior abdominal wall. This hitch resulted in adequate anteversion and anterior displacement. Cranial traction on the sutures facilitated dissection anterior to the uterus. In this position, there was also enough scope for lateral countertraction and dissection on the lateral sides. The left-upper pararectal port that was originally utilized for the myoma screw could now be used for assistance in retraction of the rectum and in suctioning. In some patients we could even avoid the above port. The problems anticipated were tearing of the uterus, inadvertent bleeding from the uterus, breaking of the suture, accidental perforation of the bladder, or abdominal wall vessel.

But apart from some difficulty in passing the suture through the abdominal wall in an obese patient and tearing of the round ligament in one patient, we did not face any other problem due to the uterine hitch. Similar techniques have been used previously for laparoscopy in benign conditions. Tsin and Colombero described the laparoscopic leash technique to prevent specimen loss during laparoscopy [6]. Giesler further extended this concept with a puppet string variation to facilitate traction and manipulation in large broad ligament fibroids [7]. The uterine hitch technique is an excellent alternative to routine manipulation techniques when operating laparoscopically on cancers in the pelvis. 5. Conclusion The hitching of the uterus is an innovative method for manipulating the uterus in several laparoscopic pelvic oncosurgical procedures. It is a simple, effective, easy, and economical technique Brefeldin_A which facilitates dissection posterior to the uterus and in cases where routine uterine manipulators are relatively contraindicated (endometrial carcinoma, pyometra).