Description

TLH total laparoscopic hysterectomy with fibroids. Unplanned video of a large uterus. Hysterectomies performed laparoscopically have increased significantly over the past few decades and even exceed the number of vaginal hysterectomies (VH). Hysterectomy is the most commonly performed major gynecological procedure worldwide. Benign conditions account for more than 70% of indications for hysterectomy and include menstrual disorders, fibroids, pelvic pain, and uterine prolapse. The initial steps of a total laparoscopic hysterectomy are performed in the same manner as for LAVH. After the broad ligament is dissected, the surgeon ties the uterine pedicle with 0 Vicryl sutures using a knot pusher. The procedure is shown where the needle is being inserted around the uterine vessels. Shows the absorbable suture being brought out of the abdomen through a 5 mm cannula after cutting and parking the needle in the peritoneum. The knot is tied using a knot pusher. Shows the internal view and external view. The uterine vessels should be ligated in two places and the vessels arising between the knots should be ligated with scissors. Hemostasis of the uterine vessels can also be achieved with bipolar forceps, which use intermittent short applications of electrical energy until the end point of cessation of flow, thus avoiding excessive heating of the ureters. It is essential to be aware of the position of the ureters and ensure that all hemostatic procedures are performed at a distance from them. The height of the uterus allows the uterus to be separated from the uterus.