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TOTAL LAPAROSCOPIC HYSTERECTOMY
THE WAY WE DO IT
TECHNIQUE, TOOLS AND VIDEO PRESANTATION
DR. MOHAMMAD ABDUL QUAYYUM
FCPS
Chief Consultant (Gynae),
Gynaecological Endoscopic Surgeon,
Feni Private Hospital, Feni, Bangladash

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Introduction
In 1989 Harry Reich performed 1st
Total Laparoscopic Hysterectomy (TLH).
Original Operation has not change in
any major degree.
However techniques and tools are
changed for safe operation.
During operation the main problems
are:
Injury to Ureter, Bladder, Rectum etc.
Maintenance of Pnemo-peritonium.

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Introduction (cont.)
This problems are minimized by
very simple, safe and easily
available tools.
The new simplified TLH technique
is the intrafascial hysterectomy
done by circumferential vaginal
incision above the attachment of
utero-sacral ligaments.

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Objective
Today I demonstrate a video
presentation showing TLH by
using Kleppinger bipolar forceps .
Purandare uterine manipulator
with a very simple device (Mineral
water bottle cap) used as vaginal
delineator to cut the vaginal vault.

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Materials & Methods
From Feb 2005 to August 2008 I
performed 505 LH of which 362
was TLH .
Under GA in modified lithotomy
position a “0”-degre 10 mm
telescope was used at the
umbilical port. Two left lateral
and one right lateral ports for
accessories.

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Materials & Methods (cont.)
I only used kleppinger bipolar forceps
for coagulation & desiccation of
vessels.
Mineral water bottle cap with
Purandare uterine manipulator used
as cervico-vaginal delineator.
Pneumoperitoneum was maintained
by sterile wet sponge vaginal pack.

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Laparoscopic tools
Kleppinger bipolar forceps (Creative).

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Laparoscopic tools (cont.)
Purandare uterine manipulator.
Mineral water bottle cap (Cervico-vaginal delineator).
Sterile wet sponges (Pnuemoocclutor).

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Application of uterine
manipulator with mineral water
bottle cap( cx. Delineator).

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Posterior laparoscopic view

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Anterior laparoscopic view

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The inside story

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Colpotomy of TLH (16 wks cervical fibroid).

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Colpotomy of TLH (Adenomyosis).

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Indications of TLH (n- 362).
Chronic
PID
55%
DUB
24%
Adnex.
mass 4%
Fibriod
6%
Other
5%
Endrom
etriosis
6%

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Results & Conclusion
No evidence of visceral or
vascular injury or immediate
post-operative bleeding .
Very minimum gas leakage after
colpotomy.
Total completion of operation
within 40-90 minutes .
Only one(0.25%) case of
intraoperative bladder injury
managed by intracorporeal
suturing.

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Results & Conclusion (cont.)
Only two(0.55%)cases of 2nd weeks
postoperative ureteric fistula managed
by urologist .
Four(1.1%) cases were converted to
lapratomy due to poor case selection
No bowel injuries.
Good postoperative recovery within 06
hours.
Discharged for home after 24-48
hours.

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At the end we can say
The simplified technique of
TLH is simple, safe, least
traumatic & highly illustrative
intrafascial hysterectomy
carried out successfully by
very simple tools.

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Thank You