Total Laparoscopic Hysterectomy

Part 1 Dissection of the ureter: the ureter being dissected; right pelvic side wall showing dissection of ureter; panoramic view after dissecting both ureters. Part 2 Reflection of the bladder flap: division of the round ligament; separating the anterior peritoneum fold from the surface of the uterus; division of the bladder flap peritoneum; dividing the tube and ovarian vessel. Part 3 Securing the infundibulopelvic ligament: securing the infundibulopelvic ligament; tissue dessication after application of bipolar forceps; dividing the dessicated infundibulopelvic ligament with spoon electrode; dividing the infundibulopelvic ligament with scissors. Part 4 Securing uterine vessels: passing a curved needle under the uterine artery; tying the suture; the uterine artery ligated; the uterine artery secured with bipolar diathermy forceps. Part 5 Circumferential culdotomy (division of the cervicovaginal attachments): entering the vagina posteriorly using monopolar diathermy; opening the anterior vaginal fornix; anterior culdotomy showing forceps protruding; freed uterus pulled out to the abdomen; fundus of the uterus acting as a plug in the upper vagina. Part 6 Laparoscopic vaginal vault closure: vaginal vault closed with laparoscopic sutures and supported by a McCall culdoplasty. Part 7 Post-hysterectomy inspection of pelvic: underwater inspection of sutures to reveal residual bleeding; Van Caille micro bipolar forceps provide additional haemostasis underwater.