Total laparoscopic hysterectomy (TLH) using the LigaSure™ Retractable L-hook Laparoscopic Sealer/Divider

This video presents a multiple laparoscopic myomectomy in a 31-year-old patient with chronic pelvic pain and metrorrhagia. Myomectomy starts after intraoperative temporary clipping of the uterine artery and infundibulopelvic vessels. This simple method allows for the prevention of massive bleeding during the excision of the myomas. Once all myomas have been enucleated, they are extracted by morcellation.

This video describes the technique of laparoscopic hysterectomy. The challenge in this case is the presence of a large fibroid uterus and distorted anatomy on the right side, which required a slightly different approach to the division of the right utero-ovarian ligament. Here is also shown the technique of morcellation using the laparoscopic blade.

The normal uterine cavity is distorted or obliterated due to severe adhesions in Asherman’s syndrome, which makes surgery difficult to perform. The high-definition vision of the camera can help to identify visual cues and clues during hysteroscopy, which can guide the surgery.
The objective of this video is to demonstrate that the information gathered from various visual cues during hysteroscopy is really helpful to the surgeon.
The video focuses on the use of the following seven visual cues: color of fibrous bands and endometrium which imparts a white spectrum; thread-like texture of fibrotic bands; lacunae and their dilatation in scar tissue; probing and post-probing analysis using scissors (5 French); color and appearance of myometrial fibers which impart a pink spectrum; vascularity differentiation; matching analysis with a normal uterine cavity.
Various techniques described for the management of this condition include fluorescence-guided, ultrasonography-guided, and hysteroscopic adhesiolysis under laparoscopic control, which are expensive procedures. We suggest that the high-definition vision and visual cues during hysteroscopy should be initially used intraoperatively for guidance purposes before using such options. It may be sufficient to achieve the desired result in most cases.

The severe form of intrauterine adhesions (IUA) is probably the most difficult pathology to be treated by hysteroscopic surgery. The use of small diameter resectoscopes facilitates faster operations and less endometrial trauma, and is expected to be more efficient for the treatment of IUA. The concomitant use of ultrasound helps the surgeon to identify the ostia and prevents him from perforating the myometrium. The main effort is to identify the endometrial and sub-endometrial cleavage plane without injuring the myometrium. Longer periods of amenorrhea, older aged patients, and repeated surgery attempts to clear adhesions reduce chances of achieving pregnancy. Postoperative Hyalobarrier® anti-adhesive agents reduce the risk of adhesion reformation but do not increase pregnancy rates.

In this lecture, the three different approaches to hysterectomy, i.e. abdominal, vaginal, and laparoscopic, are presented laying the emphasis on the laparoscopic technique. The classification of laparoscopic hysterectomy is provided and the most important functional outcome parameters are discussed in the context of an evidence-based comparison between these three approaches. The learning curve for laparoscopic hysterectomy is emphasized and the corresponding data are presented. A take home message is conveyed.

In this key lecture, Dr. Rudi Campo outlines the interest of mini-hysteroscopy as compared to conventional techniques.

When performing radical hysterectomy, the surgeon has to deal with major important structures throughout the pelvis. Different techniques have been described and since the very beginning, many modifications have been put forward. In this video, Dr. S Puntambekar explains the Pune technique for radical hysterectomy with detailed keysteps and recommendations in order to avoid major complications.

In the last century, numerous classifications of radical hysterectomy have been developed according to the knowledge gained of the anatomy. In addition, the way to perform surgery and the radicality of procedures changed over the last decades according to the development of new instruments and depending on the understanding of the pathologies.
This lecture explains the reasons why a classification is required and how it led to the development of a new classification by Querleu-Morrow in 2008.
The lecture ends with a detailed explanation of limits and landmarks of the new 4 classes of radical hysterectomy.

A step by step video showing a technique of laparoscopic radical hysterectomy, anatomy of the pelvis, obturator nerve-sparing dissection technique, margins and limits of pelvic lymph node dissection and completed with principles and steps of hysterectomy. At the end of the procedure the integrity of both ureters are clearly shown.