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STEPS OF TOTAL LAPAROSCOPIC HYSTERECTOMY
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- Bipolar dissection and division of the mesosalpinx, round ligament
and ovarian ligament. The fallopian tubes are removed wherever the ovaries
are preserved.
- Severing the infundibulopelvic ligaments if the ovaries are to be
extirpated.
- With firm cranial displacement of the uterus and the anterior fornix
with the help of uterine manipulator and the CCL extractor the uterovesical
peritoneum is opened and extended laterally to the broad ligament to
enter the pelvic cellular tissue space where the uterine artery is coursing
medially on the surface of the transverse cervical ligament.
- Marinating firm cranial pressure on the anterior fornix the supravaginal
ligament in the middle, and the bladder pillars (pubocervical ligaments)
laterally are severed with monopolar spatula or hook electrode (at 90
watts of unmodulated current) to achieve sufficient downward displacement
of the bladder exposing 1 to 2 cms of the anterior vagina.
- Strong cephaloid push of the uterus and stretching the vaginal fornix
at this point brings the ascending uterine vessels at easy and safe
access for bipolar dessication and division. To identify the right uterine
artery the uterus is displaced upwards and to the left side and vice
versa. The uterine artery is safely distanced from the ureter by 4 cms
by this manipulation.
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