Rectal Injury Due to the Incorrect Insertion of a Vagi-Pipe Into the Rectum During Total Laparoscopic Hysterectomy: A Case Report.

Total laparoscopic hysterectomy (TLH) is the most common gynecologic surgery. The use of a vaginal pipe to facilitate TLH is a popular method for enabling incision into the vaginal canal. However, this device is associated with serious complications. We report the case of a patient who underwent laparoscopic low anterior resection due to rectal injury caused by the incorrect insertion of a Vagi-Pipe (Hakko Co. Ltd., Nagano, Japan) into the rectum during TLH for endocervical positive margins after conization of cervical intraepithelial neoplasia. In the present case, the narrow vaginal orifice made it difficult for the assistant surgeon to distinguish between the vagina and anus. Based on this experience, a change was made at our institution to cover the anus with a cloth to prevent misidentification. Surgeons performing TLH should be mindful that the use of a vaginal pipe can lead to incorrect insertion into the rectum.