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Total Laparoscopic Hysterectomy by Grace Chen, MD
Authored by
Grace Chen, MD
Authored by
Grace Chen, MD
Total Laparoscopic Hysterectomy by Grace Chen, MD
Operative Steps
Operative Steps
- Access to abdomen is generally gained in one of the 3 ways: Veress needle; direct/optical entry and open entry.
- Anatomic survey is usually performed including pelvic and upper abdomen with particular attention to the course of the pelvic ureters.
- If necessary, adhesiolysis is performed.
- Round ligaments are ligated and divided using an energy device such as HARMONIC™ 1100 or Enseal ™ X1.
NOTE: to prevent bleeding it may be helpful to divide round ligament at midpoint.
- If fallopian tubes are being removed (conserving ovaries), the mesosalpinx is ligated and divided.
- Utero-ovarian ligaments are transected using an energy device such as HARMONIC™ 1100 or Enseal™ X1.
- If ovaries and fallopian tubes are being conserved, isthmus of fallopian tubes and utero-ovarian ligaments are ligated and divided.
- If ovaries and fallopian tubes are being removed, infundibulopelvic (IP) ligaments are ligated and divided using an energy device such as HARMONIC™ 1100 or Enseal™ X1.
- Broad ligament is incised until uterus reached using an energy device such as HARMONIC™ 1100 or Enseal™ X1.
- Anterior and posterior leaf of broad ligament is separated and incised to skeletonize uterine vessel and lateralize ureters using an energy device such as HARMONIC™ 1100 or Enseal™ X1.
- Vesicouterine peritoneum is incised and bladder dissected away from uterus, cervix and upper vagina (creating the bladder flap) using laparoscopic scissors.
- Uterine artery and vein are skeletonized, ligated, and divided using an energy device such as HARMONIC™ 1100 or Enseal™ X1.
- Cardinal and uterosacral ligaments are divided.
- Colpotomy is performed with an electrocautery hook such as MEGADYNE™ E-Z Clean™ Electrosurgical Electrodes.
- Uterus is extracted trans-vaginally.
- Vaginal cuff is closed with an absorbable synthetic suture, like Coated Vicryl® Plus. Antibacterial suture or a knotless tissue control device such as STRATAFIX™ Knotless Tissue Control Device.
- Trocars are removed. The wounds are closed using synthetic absorbable monofilament, such as Monocryl® Plus Antibacterial suture, and a topical skin adhesive such as DERMABOND ™PRINEO™ Skin Closure System or any appropriate dressing.