Description

Total Laparoscopic Hysterectomy is a minimally invasive surgical procedure to remove the uterus entirely, including the cervix, using laparoscopic instruments and a camera inserted through small incisions in the abdomen. This procedure is performed to treat various gynaecological conditions, including fibroids, endometriosis, uterine prolapse, and certain cancers. Here are the steps, indications, and a brief note on why surgeons should be skilled in this technique:

Steps:

1. Anesthesia: The patient is placed under general anesthesia.
2. Incisions: The surgeon makes small incisions in the abdomen to access the pelvic area.
3. Pneumoperitoneum: Carbon dioxide gas is introduced into the abdomen to create space for visualization and manipulation.
4. Insertion of Laparoscope: A laparoscope (a long, thin camera) is inserted through one of the incisions to provide a magnified view of the pelvic organs on a monitor.
5. Instrument Insertion: Additional small incisions are made for the insertion of surgical instruments, such as graspers and scissors.
6. Uterine Manipulation: The surgeon carefully separates the uterus and its supporting structures from the surrounding tissues.
7. Uterine Removal: The uterus is dissected free from its attachments and removed through one of the incisions or morcellated (cut into smaller pieces) to facilitate extraction.
8. Closure: The surgeon closes the vaginal cuff, which is the upper part of the vagina where the cervix used to be, to prevent complications.
9. Closure of Incisions: All incisions are closed with sutures or staples.

Indications:

Total Laparoscopic Hysterectomy is indicated for various gynecological conditions, including:

1. Uterine Fibroids: Large or symptomatic fibroids causing pain, bleeding, or other symptoms.
2. Endometriosis: Severe endometriosis that does not respond to conservative treatment.
3. Uterine Prolapse: When the uterus drops into or beyond the vaginal canal.
4. Gynecological Cancers: For certain cases of uterine, cervical, or ovarian cancer.
5. Adenomyosis: A condition where the uterine lining grows into the uterine muscle, causing pain and heavy bleeding.

Gynaecological surgeons should be proficient in Total Laparoscopic Hysterectomy because it offers several advantages over traditional open surgery, including shorter recovery times, reduced pain, and smaller scars. It’s essential for gynaecological surgeons to master this minimally invasive technique as it provides patients with a less invasive option for treating various gynaecological conditions while minimising postoperative discomfort and enhancing the overall surgical experience.