Total Laparoscopic Hysterectomy

Identify UV Fold by rotating the Funnel Edge

anteriorly.
Mark dissection lines on peritoneum with
Bipolar Forceps or gently with Monopolar
Scissors.
Dissect on the medial edge of your
dissection line, as the lateral edge will be
displaced by the CO2 pressure.
UV FOLD LIFTED BY FUNNEL
EDGE.

THIS CAN BE USEFUL IN

ABDOMINAL OPERATIONS
U / V FOLD
MARK DISSECTION
LINES ON ANTERIOR
FOLD OF BROAD LIGT
FROM UV FOLD UP TO
ROUND LIGAMENT
WITH MONOPOLAR
SCISSORS.
START DISSECTION WITH
OVARIAN LIGAMENT AND
THEN THE TUBE, WORKING
UP TO THE ROUND
LIGAMENT AS VESSELS ARE
POSTERIORLY PLACED IN
THESE STRUCTURES.
DISSECT BROAD LIGAMENT
DOWN TO LEVEL OF
UTERINE VESSELS.
I DO NOT SEPARATE THE
LEAVES OF THE BROAD
LIGAMENT AS THIS TENDS
TO DISTORT THE
DISSECTION LINES.
YOU WILL COME ACROSS
THE UPPER BRANCH OF
THE UTERINE ARTERY IN
THE BROAD LIGAMENT
BEFORE YOU ENCOUNTER
THE UTERINE PEDICLE.
COAGULATE THIS BRANCH
WITH BIPOLAR ENERGY
AND DIVIDE IT.
USE THE HOOK DISSECTOR
TO PULL THE LARGE
UTERINE HOOK
DISSECTOR
DO THE SAME ON THE OTHER
SIDE DOWN TO THE LEVEL OF
THE UTERINE VESSELS
PEDICLE.
WITH MONOPOLAR ENERGY,
COMPLETE THE UV FOLD
DISSECTION ON THE
FUNNEL EDGE. PUSH THE
FOLD DOWNWARDS UNTIL
THE VAGINA IS APPARENT.
YOU DO NOT HAVE TO
UNDERMINE THE BLADDER
THE UTERINE PEDICLE
IS DISPLAYED FROM
THE LATERAL EDGE
OF THE FUNNEL AS
SHOWN.
THE UTERINE PEDICLE IS
SECURED WITH A CURVED
NEEDLE I VICRYL SUTURE.
MAKE SURE THE FUNNEL
EDGE IS ANTERIOR.
INSERT NEEDLE FROM
LATERAL SIDE OF THE
FUNNEL EDGE
DOWNWARDS.
CURVE NEEDLE AROUND
THE UTERINE PEDICLE.
USING SINGH UTERINE
ARTERY NEEDLE TO
SECURE PEDICLES,
INTRODUCED AT
SUPRAPUBIS.
NEEDLE
PLACEMENT FOR
LEFT PEDICLE.
RETROVERT
UTERUS AND
PUSH NEEDLE
DOWN TO BLACK
MARK.BLACK
MARK
NEEDLE PLACEMENT
FOR RIGHT PEDICLE
ANTEVERT UTERUS. NEEDLE TIP
SHOULD APPEAR AS SHOWN
WITH KNOT ON SUTURE.
PULL ON
SUTURE END
SUTURE AROUND LEFT
PEDICLE
INTRA CORPORAL TIE.
EXTRA CORPORAL
SLIDING KNOT.
After tieing the uterine pedicles, I bipolar medially before dividing the uterine pedicles. If you do not wish to tie
your uterine pedicles,you can bipolar them using the edge of the Funnel as your lateral margin.

Rotate the funnel edge anteriorly and cauterise the vagina on the funnel edge until the funnel is nearly visible.

Rotate the funnel edge laterally to the Right fornix and dissect the Makenrodt ligament on the funnel edge,
displacing the uterine pedicle. Cauterise the vagina on the funnel edge until the funnel is visible.

Insert bipolar forceps medial to the funnel edge and then cut the vagina with scissors. By using bipolar first
before cutting the vagina, you minimise bleeding and bowel damage. I used to use monopolar cautery but find
the bipolar and scissors method just as quick. Keep rotating the funnel shaft posteriorly and repeat bipolar and
scissors to the uterosacrals and enter the posterior edge. Keep dissecting on the funnel edge and you are well
clear of the ureters.

Rotate the funnel to the other uterine pedicle and repeat the procedure so the lateral and posterior vaginal
vaults are divided.

FOR CO2 LEAKAGE, INSERT THE VAGINAL PLUG ONTO THE FUNNEL AS
SHOWN IN THE EARLIER SLIDES. INSERTING A WET PACK INTO THE VAGINA
OR LOOSEN THE ORING ON THE SUC AND PULL THE FUNNEL INTO THE
VAGINA CAN ALSO HELP.
I used to enter the anterior fornix first, but I now find it easier and quicker to enter laterally as soon as
the uterine pedicles are displayed laterally. Divide the Macenrodt ligaments down to the vagina and then
work posteriorly. The anterior fornix is then divided to free the cervix from the vagina.