Total laparoscopic hysterectomy with extensive endometriosis
by Jain Nutan, Jain Vandana, Kanawa Swati

Comprehensive Video Atlas of Laparoscopic Surgery in Infertility and Gynecology

by Nutan Jain
About Video

In this video case of 42-years-old female patient, present complaints severe pain during menses, menorrhagia and dyspareunia. Sonography: adenomyotic uterus and right large homogenous cystic mass with internal echoes. Presumptive diagnosis: Adenomyosis uterus with right endometriotic cyst. Port placement: Patient laid in modified lithotomy position under GA. Four ports laparoscopy done, all the ports are 5 mm except camera port which is 10 mm. Surgical procedure: On inserting the 10 mm 30° telescope retroverted uterus with right sided large endometriotic cyst, which were densely packed in pouch of Douglas seen. Both ovaries and tubes are also stuck to the back surface of uterus, bilateral uterosacral ligaments and ovarian fossa. Tubes are dilated, left ovary comparatively normal. First, we started clearing the pouch of Douglas and bilateral densely adherent ovaries. During dissection right ovary drained of copious amount of chocolate material, which is sucked out. Antegrade blunt and sharp dissection was done and ovaries cleared from pouch of Douglas. On both side ureteral dissection done up to the uterosacral ligaments. Bilateral pararectal spaces cleared up with lateral mobilization of ureters. Both nodular uterosacral ligaments excised. Rectal probe and vaginal sponge are used to help in dissection of rectovaginal space and rectum mobilized downwards. The pouch of Douglas and rectovaginal space totally cleared. As the patient is young and she also wants to preserve atleast her one ovary so left ovary is preserved. TLH with right salpingo-oophorectomy done using vessel sealer. Right and left handed KOH needle holders applied in ipsilateral suturing for the vaginal vault closure. Vault closure with uterosacral ligament suspension done in continuous double layer using vicryl 1-0.

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