Clinics in Mother and Child Health

Abstract

Benefit of Add-Back Therapy in Total Laparoscopic Hysterectomy for Benign Uterus Disease

Tomoko Hagiwara* and Hiroyuki Kobori

Total Laparoscopic Hysterectomy (TLH) is already the standard procedure for benign uterine disease such as fibroids and adenomyomas and is the first choice in many centres in Japan. The number of nulliparous women is increasing, as is the weight of the uterus removed due to the expanding range of indications. The strain on the vaginal wall during specimen extraction is therefore greater than in the past. Preoperative Gonadtropin-Releasing Hormone analogue (GnRHa) therapy facilitates TLH for uterine fibroids and adenomyomas reduces the size of the uterus, resulting in less intraoperative blood loss and operating time. However, GnRHa use can cause vaginal atrophy, making transvaginal procedures difficult. We were the first in the world to evaluate the association between efficacy of preoperative vaginal estriol use as add back therapy for TLH with GnRHa therapy and intraoperative and postoperative outcomes.

Published Date: 2024-10-17; Received Date: 2024-09-16