About Video

This video demonstrates single-incision laparoscopic hysterectomy. Total laparoscopic hysterectomy is an accepted standard procedure in women with benign gynecological conditions. The main concern in an enlarged uterus is the associated with intraoperative blood loss. Prior ligation of the uterine arteries (ascending branch or uterine artery ligation at origin) considerably reduces the average blood loss during hysterectomy. Under general anesthesia, patient is placed in modified lithotomy position, bladder catherized. We use one supraumbilical 10 mm port for the telescope and three 5 mm accessory ports (2 left lateral and 1 right lateral) for all our cases. Uterine manipulation is done using a 5 mm myoma spiral. To ligate the uterine artery at its origin, dissection is started from the anterior leaf of the broad ligament. The triangle enclosed by the round ligament, external iliac artery and infundibulopelvic ligament is opened and the areolar space dissected to identify the uterine artery, which is a branch of the anterior division of the internal iliac artery. The uterine artery is skeletonized and ligated with a free vicryl tie or occluded with vascular clips. Once the vessels are secure, the uterovesical fold of peritoneum is identified and opened from the round ligaments on either side. The bladder is dissected down completely. The decrease in the vascularity of the uterus can be appreciated by the uterus becoming pale in color. Bilateral cornual structures are dessicated and cut. If the ovaries need to be removed then the infundibulopelvic ligaments are dessicated and cut. Finally, the uterosacrals and cardinal ligaments are cut to open the vaginal vault and the uterus with cervix separated from the vagina. The specimen is delivered vaginally if small. In case of a large uterus the specimen can either be morcellated by using electromechanical morcellator or by cutting it vaginally into small pieces. The fallopian tubes are removed in all cases where we plan to conserve the ovaries. The vaginal vault is then sutured using No. 1 delayed absorbable sutures.