Total Laparoscopic Hysterectomy (TLH) is a minimally invasive surgical procedure used for the removal of the uterus through small abdominal incisions. It has gained popularity as a safer and less invasive alternative to traditional open surgeries for various uterine conditions, including fibroids. Large lateral wall fibroids are a common indication for TLH due to their potential to cause significant symptoms and complications. This essay explores the key aspects of TLH for large lateral wall fibroid uterus, including its advantages, surgical technique, patient selection, and postoperative outcomes.
Advantages of Total Laparoscopic Hysterectomy:
Minimally Invasive Approach: TLH is performed through small incisions in the abdominal wall, reducing the trauma to surrounding tissues compared to traditional open surgery. This results in less pain, quicker recovery, and shorter hospital stays for patients.
Reduced Blood Loss: The precise nature of laparoscopic surgery, along with the use of specialized instruments, allows for better control of blood vessels, leading to reduced intraoperative blood loss.
Minimal Scarring: The small incisions used in TLH result in minimal scarring, which is not only cosmetically favorable but also contributes to the patient's psychological well-being.
Faster Recovery: Patients undergoing TLH typically experience a faster recovery time compared to open surgery. This means they can return to their daily activities sooner, with less disruption to their lives.
Surgical Technique for Large Lateral Wall Fibroid Uterus:
The surgical technique for TLH involves several key steps:
Patient Positioning: The patient is placed under general anesthesia and positioned in the lithotomy position. Carbon dioxide gas is then introduced into the abdominal cavity to create a pneumoperitoneum, allowing for better visualization.
Trocar Placement: Several small incisions are made in the abdominal wall to insert trocars, which serve as entry points for the laparoscopic instruments. These instruments include a camera and specialized surgical tools.
Uterine Manipulation: The uterus is carefully manipulated and dissected to identify the fibroids and their blood supply. The surgeon must be meticulous to ensure complete removal of the fibroids without causing damage to surrounding structures.
Uterine Artery Ligation: The blood supply to the uterus is ligated, typically by sealing the uterine arteries using techniques such as bipolar coagulation or vascular clips. This step reduces blood loss during the procedure.
Uterine Removal: The uterus is detached from its ligaments and supportive structures. It is then morcellated (cut into smaller pieces) and removed through one of the small incisions.
