Description

Total Laparoscopic Hysterectomy (TLH) is one of the most advanced minimally invasive gynecological surgeries performed for conditions such as fibroids, adenomyosis, abnormal uterine bleeding, endometriosis, and early-stage malignancies. With the evolution of energy sources and precision instruments, TLH has become safer, faster, and associated with minimal complications. Among the innovative tools, RoBi bipolar instruments and the ultrasonic dissector play a pivotal role in ensuring effective hemostasis, precise dissection, and reduced thermal spread to surrounding tissues. Role of RoBi in TLH RoBi (Rotatable Bipolar) instruments are designed specifically for advanced laparoscopic surgeries. They provide 360° rotation, fine tip dissection, and strong coagulation capability, which is essential during hysterectomy where vascular pedicles like the uterine vessels require secure sealing. Key advantages include: Excellent hemostasis with minimal lateral thermal damage. Ergonomic design for surgeon comfort and precise handling. Reduced instrument exchanges due to multifunctional ability (grasping + coagulating). Enhanced control during difficult dissections such as in dense adhesions or large uteri. Role of Ultrasonic Dissector in TLH The ultrasonic dissector (commonly known as Harmonic scalpel) works by vibrating at ultrasonic frequency, which cuts and coagulates tissue simultaneously. It is particularly effective in areas where precision and reduced collateral tissue damage are necessary. Advantages include: Precise cutting with simultaneous coagulation. Minimal smoke formation compared to monopolar cautery. Reduced postoperative pain due to less thermal injury. Efficient dissection of broad ligament, bladder peritoneum, and adnexal structures. Surgical Steps of TLH with RoBi and Ultrasonic Dissector Patient Positioning and Port Placement – Under general anesthesia, patient is placed in lithotomy with steep Trendelenburg. Four ports are typically used. Inspection and Adhesiolysis – Initial pelvic assessment and adhesiolysis performed with ultrasonic dissector for sharp and atraumatic dissection. Broad Ligament Dissection – Ultrasonic dissector is used for precise separation of peritoneum and bladder flap. Sealing of Pedicles – RoBi instruments are used for coagulation and division of infundibulopelvic ligament or utero-ovarian ligament, round ligament, and uterine vessels. Colpotomy – Can be performed using ultrasonic dissector, ensuring smooth and bloodless incision around the cervix. Specimen Removal – Uterus is removed vaginally or through morcellation if required. Vault Closure – Performed laparoscopically, usually with barbed sutures. Final Hemostasis Check and Desufflation – Ensuring no bleeding points before closure. Advantages of Combining RoBi and Ultrasonic Dissector Synergistic effect: RoBi ensures secure vascular sealing, while ultrasonic dissector provides precision in delicate tissue planes. Reduced operative time and blood loss. Safer dissection in difficult pelvic anatomy or distorted planes. Lower risk of thermal spread compared to traditional monopolar cautery. Faster recovery with minimal postoperative complications. Conclusion Total Laparoscopic Hysterectomy with RoBi and Ultrasonic Dissector represents the integration of advanced bipolar technology and ultrasonic energy to achieve maximum safety, efficiency, and patient comfort. The combination offers surgeons improved control, versatility, and precision, making it an ideal approach for complex hysterectomies. With these technological advancements, TLH continues to evolve as the gold standard for uterine removal in benign and selected malignant conditions.