Total laparoscopic hysterectomy with newly designed uterine manipulator (Halder’s): Safety, efficacy and perforation prevention

Abhijit Halder, Indranil Dutta


Objective: The objective of the study is to evaluate the safety and efficacy of the new uterine manipulator (Halder’s) in performing Total Laparoscopic hysterectomy (TLH) and to determine whether it prevents perforation of uterus due to forward pushing force.

Introduction: Hysterectomy is one of the most common gynaecological operation performed worldwide of which laparoscopic approach is now a days preferred alternative route compared to open abdominal hysterectomy. According to U.S. Surgical data, there is a decrease of trend of abdominal hysterectomy from 65% to 54% in favour of laparoscopic route in between 1998 to 2010. It is because laparoscopic approach is associated with shortened hospitalization and postoperative recovery times and low morbidities. But it requires specialized training and skill to perform successfully. Manipulation of uterus during TLH is a vital step to avoid inadvertent injuries of vital organs like ureter, bladder and gut. Hence the newly designed uterine manipulator (Halder’s) is developed to simplify TLH with its inherent quality of ease of use and simplicity. Special feature of this manipulator is the Cervical Guard with rotational forward and backward movement which distinguishes it from the all available manipulators in the market.

Material and Methods: From March 2018 to May 2019, 246 cases were done laparoscopically following a standard and simple technique using Halder’s uterine manipulator in different centres in West-Bengal of which 200 cases were shortlisted as they fulfilled the inclusion criteria’s of Halder’s manipulator. After introduction of Halder’s uterine manipulator through cervix, the operation was performed using bipolar or ultrasound energy for coagulation and cutting the vascular pedicles and ligaments. The entire procedure was done laparoscopically and the uterus was removed vaginally. The vaginal cuff was closed by continuous suture in single layer with polyglactin material.

Results: Most common indication was Abnormal uterine bleeding due to Leiomyoma(AUB-L), the average weight of uterus was 22095gms. Mean operation time was 64.65.5 minutes. Estimated blood loss was 80ml20 ml. There was no bowel injury but one ureteric injury, one Bladder injury and one uterine perforation were found. Great ranges of movement found during manipulation.

Conclusion: The easy, smart and simple Halder’s uterine manipulator could be the option to do TLH, in reducing the complications and having more favourable operative outcomes. This manipulator can be used by inexperienced persons at vaginal end.


Keywords: Total laparoscopic hysterectomy, Quality assessment questionnaire sheet, Halder’s uterine manipulator, Cervical guard, Utero-cervical insert, Colpotomy tube, Colpotomy tube fixation screw

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YouTube video demonstration. (