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Total Laparoscopic Hysterectomy Under Regional Anesthesia

Moawad, Nash, S., MD, MS; Santamaria Flores, Estefania, MD, MPH; Le-Wendling, Linda, MD; Sumner, Martina, T., PhD; Enneking, F., Kayser, MD

doi: 10.1097/AOG.0000000000002618
Contents: Minimally Invasive Gynecologic Surgery: Case Report

BACKGROUND: Laparoscopic hysterectomies comprise a large proportion of all hysterectomies in the United States. Procedures completed under regional anesthesia pose a number of benefits to patients, but laparoscopic hysterectomies traditionally have been performed under general anesthesia. We describe a case of total laparoscopic hysterectomy under epidural anesthesia with the patient fully awake.

CASE: A 51-year-old woman with abnormal uterine bleeding underwent an uncomplicated total laparoscopic hysterectomy, bilateral salpingectomy, and excision of endometriosis. The procedure was completed under epidural anesthesia without intravenous sedation or systemic narcotics. Pneumoperitoneum with a pressure of 12 mm Hg and Trendelenburg to 15° allowed for adequate visualization. Anesthesia was achieved with midthoracic and low lumbar epidural catheters. Bilevel positive airway pressure was used for augmentation of respiratory function.

CONCLUSION: With a committed patient, adequate planning, and knowledge of the potential intraoperative complications, regional anesthesia is an option for select women undergoing laparoscopic hysterectomy.

Laparoscopic hysterectomy under regional anesthesia is a feasible option with a committed patient, appropriate planning, and adequate counseling.

Section of Minimally-Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, and the Division of Acute and Perioperative Pain Medicine, Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida; the Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, Massachusetts; and the Department of Chemistry, University of Florida, Gainesville, Florida.

Corresponding author: Nash S. Moawad, MD, MS, University of Florida College of Medicine, Obstetrics and Gynecology, PO Box 100294, Gainesville, FL 32610-0294; email:

Each author has indicated that he or she has met the journal's requirements for authorship.

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.