Ability to perform laparoscopic hysterectomy without using uterine manipulator

The uterine manipulator is usually presented as an integral element of laparoscopic hysterectomy. Its use makes it possible to conveniently position the uterus during surgery, reduce the risk of trauma to the ureters, bladder, and rectum, and its cuff prevents the loss of gas from the abdominal cavity during colpotomy and creates a guideline for cutting off. Along with the advantages in operations for endometrial cancer, there are also limitations, namely, that the use of a uterine manipulator leads to an increase in the frequency of lymphovascular invasion of the tumor, the appearance of malignant cells in peritoneal washings, creates a risk of uterine perforation and can cause pseudoinvasion of the myometrium. However, at the present stage, the evolution of surgical instruments has made it possible to develop an accessible method of surgery that eliminates the need to use uterine manipulator. The study obtained results demonstrating not only the possibility of implementing this technique in practice, but also certain advantages of the method in the form of reducing operation time (76.3 minutes in the group without uterine manipulator versus 103 minutes in the group with a manipulator (p=0.036265), and reduction of blood loss: 150 minutes versus 34.3 (p<0.005). The use of uterine manipulator at the present stage is not necessary, especially during operations for malignant tumors of the uterus.