Rumi uterine manipulator

All of the patients were administrated general anesthesia in the lithotomy position. A Foley catheter and a RUMI uterine manipulator (CooperSurgical Inc., Trumbull, CT, USA) were both inserted preoperatively. During surgery, frozen biopsies were performed when the leiomyosarcoma was suspicious, showing features such as necrotic change. It was not present in the C-RSSM group, but three cases were performed in the RSSM group, which were all benign.

All the operations were performed under general anesthesia with endotracheal intubation, and standard intramuscular cephalosporin antibiotics were used for prophylaxis. The patients were then placed in a modified lithotomy position, with the hips at an approximate 180° extension, the knees flexed at almost 90°, and with the table tilted in a nearly 45° Trendelenburg position. Both arms were tucked along the patient's side. A 10mm trocar (Endo Ethicon) was inserted directly from the umbilicus, and pneumoperitoneum was generated until an intra-abdominal pressure of 14mmHg was achieved. Three additional 5mm ports were inserted under direct visualization of the lower intra abdominal area; median, left, and right from 2 cm medial and superior to the anterior superior iliac crests. Following sterilization of the skin and covering of the patient, a RUMI^© uterine manipulator with a Koh Cup™ colpotomizer (Cooper Surgical; Trumbull, Connecticut, US) was trans-vaginally introduced at the beginning of the procedure. The surgeon stood on the patient's left, and the first assistant handled the scope on the patient's right. The second assistant was positioned between the legs of the patient. Operation time began with the first skin incision and ended with the final closure of an incision.