Minimally Invasive TLH

Abstract

Study Objective: The purspose of this video is to introduce a method of minimally invasive TLH. This operation consists of three steps. The first is identification and dissection of the ureter with minimally invasive procedure. This is performed by dividing the round ligament followed by dissection of the posterior leaf of the broad ligament near the uterine cervix. The second step of this operation is the procedure for the adnexa. Fenestration of the posterior leaf is the key to preserve or to remove the adnexa safely. The third step of this operation is removal of the cervix without risk of ureteral injury. To achieve this, we are using modified intrafascial (Aldridge's) method with a uterine manipulater and an ultrasonic scalpel. With this method, TLH can be performed with little bleeding, without risk of ureteral injury, with preservation of pelvic support system with full vaginal length.