Total laparoscopic hysterectomy for uterine fibroma
Koh colpotomizer system
Koh colpotomizer system is useful to push up the uterine cervix and prevents the leak of insuflated gas after colpotomy.
Very large uterine multiple fibroma (45-year-old nulliparous woman)
retroperitoneal dissection by anterior approach (identifing right uterine artery and right ureter)
Retroperitoneal spece is opened after cutting anterior broad ligament. Right uterine artery is ligated after identifing left uterine artery and ureter.
The coagulation and cutting of uterine upper ligamments
Left round ligament, tube, and ovarian ligament are coagulated and cut by harmonic scalpel.
After anterior and posterior colpotomy, cutting line become clear. The risk of utereral injury and bleeding is minimazed.
The advantage of using Koh colpotomizer system
The distance between cutting line and the ureter will be more than 2cm because uterine cervix is pushed up with Koh cup. When you do it without Koh cup, you cannot find any land mark where you should coagulate and cut. The risk of uteretal injury would be higher.
Coagulating and cutting left uterine vessels (cardinal ligament)
Uterine vessels were coagulated and cut with ultrasonic shears (harmonic scalpel). The procedure is safer than using bipolar energy.
Incising left vaginal wall
Extract of the uterus through electric morcellator
The uterus is extracted by morcellator when it is very difficult to take it out through vagina.
The vagina was closed in two layers.
The surgery was finished after irrigation of peritoneal cavity.
Operating time 2 hours 50 minutes
Blood loss 50g
Uterine weight 890g
Observe the video of this case
The advantage of total laparoscopic hysterectomy
TLH is a difficult and challenging since surgeons have to do all procedure through laparoscopy. Usually it takes longer to finishe the surgery. However, when it is done by experts, blood loss would be smaller and the pain would be lesser. Patients can go home earlier.