About Video

This video illustrates single-port laparoscopic hysterectomy in patient with severe endometriosis. A single 2.5 vertical umbilical incision is made and abdominal cavity was accessed as with open technique. Uterine manipulator inserted through cervix. A multichannel single-port placed. Pneumoperitoneum created using CO2 gas and 14 mm Hg intra-abdominal pressure maintained. 45 cm long 30° telescope 5 mm diameter is inserted. A 6 × 6 cm right sided endometrioma noted. Retroperitoneal dissection started at the left side pelvic brim. Left sided ureteral dissection done up to uterine artery from uterine vessel. Left sided infundibulopelvic ligament and round ligament grasped, coagulated and transacted using bipolar energy source. Dissection continues up to vesicouterine junction and then turned 90° towards cervix to avoid injury to descending branch of uterine vessel. Right ovarian endometrioma punctured and aspirated chocolate colored material. Adhesions between right ovary and right pelvic sidewall are lysed. Right side ureteral dissection done up to uterosacral ligament. Then endometriotic nodule is excised from right uterosacral ligament. Rectal probe inserted to facilitate rectosigmoid dissection from adjacent adhesions. The contralateral infundibulopelvic and round ligament grasped, coagulated and transacted. Uterovesical fold of peritoneum pushed down. Bilateral uterine artery tackled with articulating Enseal. Vaginal cuff is delineated by uterine manipulator and colpotomy done using harmonic safely. Uterus removed through colpotomy site. Vault closure done with curved needle with 3 intermittent stitches. At the end abdominal closure done.