A 47 years old lady reported with menorrhagia on ultrasound shows fibroid uterus. As she had completed her family so total laparoscopic hysterectomy with bilateral salpingectomy was planned for her. The left adnexa are being detached by using the harmonic and the uterovesical fold has been opened up. Go up to next round of ligament of the right side to separate out the uterovesical fold, after having reflected the bladder the uterine were done. And the uterosacral are detached from the uterus so that specimen little mobile. The vault is being opened from the left side. The whole process of the vault opening is taken right up to the right side because it’s become easier to access from the right side. Now the right adnexa are detached and the right ovarian ligament, right tube, as well as round ligament they are excised using harmonic. Any small bleeders should be taken care at that movement with the bipolar. Now uterine are being done on the right side. The vault is opened from the right side as well. The process of hysterectomy is completed. The cervix and uterus is totally detached. The hemostasis is checked and specimen is parked in the upper abdomen for a while. The salpingectomy on the right side on progress. Ovarian cyst on the right side is verified and ovarian cystectomy done. Both the specimen they were parked in the vagina. As its opening is much easier because the smaller specimen can get lost in the abdomen. Here left salpingectomy is in progress using the harmonic and this left tube is also parked into the vagina.
Whole the cervix with the tooth forceps and extract it through the vagina again. If the specimen is big we morcellate it vaginally otherwise it can be retrieved it from the vaginal without mocellation. The vault is stitched using number one migrill suture here we are not using quill suture. number one migrill suture is adequately sufficient in this particular surgery from one to the other side. The suturing is being done and it is very good to do the vault suspension. That is what gives you the added advantage in total laparoscopic hysterectomy that you can stitch the ureterosacrals to the vault and give it a good support. So there is less chances to prolapse. The needle is removed and hemostasis is checked. Thank You.