TLH ( TOTAL LAPAROSCOPIC HYSTERECTOMY)
Hysterectomies are one of the most common surgical procedures. For decades, abdominal and vaginal approaches accounted for the vast majority of hysterectomies. The advent of better laparoscopic technology resulted in the first total laparoscopic hysterectomy (TLH) in 1989. Use of TLH has increased in the last 20 years In the past few years, many surgeons have performed a portion of the hysterectomy using a laparoscope. Called a laparoscopically assisted vaginal hysterectomy (LAVH), the procedure requires an incision deep within the vagina, through which the uterus and related organs are removed. The LAVH still involved a transvaginal approach and decreased healing time, similar to a total vaginal hysterectomy With advanced laparoscopic skills, surgeons are able to perform TLH. The surgery is completed utilizing only four tiny abdominal incisions less than one-quarter to one half an inch in length. Even a large uterus can be removed laparoscopically using this technique. A traditional open hysterectomy requires an abdominal incision of four to eight inches.
A TLH is defined by the laparoscopic ligation of the ovarian arteries and veins with the removal of the uterus vaginally or abdominally, along with laparoscopic closure of the vaginal cuff. This is in contrast to other methods of removing the uterus, fallopian tubes, and ovaries.
The advantages of TLH compared to abdominal hysterectomy have been well documented. Visualization of pelvic anatomy and the ability to minimize blood loss is superior with TLH. Substantial and dynamic access to the uterine vessels, vagina, and rectum is possible from many angles, especially after introduction of the uterine manipulator in 1995. The advantages of TLH have been firmly established to include reduced short-term morbidity (less blood loss, wound infections, and postoperative pain), shorter hospital stay, and faster resumption of normal activities when compared with abdominal hysterectomy.
Indications
Indications for a total laparoscopic hysterectomy (TLH) are similar to those for total abdominal hysterectomy (TAH) and may include leiomyomata, pelvic organ prolapse, and abnormal uterine bleeding.TLH may be advantageous, primarily those in which a vaginal hysterectomy may be difficult. Frequently, access to the uterus can be complicated by adhesions, a narrow subpubic arch, a nulliparous pelvis, or leiomyomas, whether they are multiple, large, or found in the lower uterine segment. In these cases, laparoscopy can be used to free adhesions and divide the upper pedicles, allowing for a laparoscopic-assisted vaginal hysterectomy. Oophorectomies can be challenging when approached vaginally, whereas laparoscopic oophorectomies are a natural extension of TLH.
Benefits
Post surgically, patients have a much quicker recovery, usually going home the second day from the hospital. Often, patients are able to return to their normal routine in one to two weeks. Patients report less pain, minimal post-surgical narcotic pain medication use, and a faster recovery time than women undergoing abdominal hysterectomies who usually require a three to four-day hospitalization and lengthy recovery time of usually six to eight weeks.
Contraindications
There are no absolute contraindications to a total laparoscopic hysterectomy (TLH) for benign gynecologic diseases. Patient-specific contraindications to laparoscopy may involve a pelvis with severe adhesive disease, obstructive leiomyomata, or any other anatomic limitation that prevents safe entry into or inadequate working space in the abdomen. Patients with a history of repeat cesarean sections, multiple laparotomies, or midline incisions have up to a 50% chance of organ adhesion in the umbilical area. Risk factors for conversion to laparotomy include elevated BMI, increased uterine width greater than 10 cm, lateral or lower uterine segment fibroids over 5 cm, and previous adhesion-forming abdominopelvic surgery.
At our center at Gopi Krishna Laser Stone Center we have STRYKER 1588 AIM PLATFORM camera system with
IRIS: Infrared Illumination System
IRIS is a visualization technology designed to reduce the risk of ureteral damage. When IRIS mode is activated on the L10 light source, a lighted stent transilluminates the ureters
Clarity: Video Enhancement System
A real-time video enhancement device designed to amplify visualization by improving clarity, contrast and detail. This military grade technology helps you see through smoke and sub optimal conditions by improving image quality up to 48%.
These systems help us to operate efficiently with better results.