Description

🧬 Total Laparoscopic Hysterectomy (TLH) – Complete Overview A Total Laparoscopic Hysterectomy (TLH) is a minimally invasive surgery in which the entire uterus (including the cervix) is removed using laparoscopic instruments, with no open abdominal incision. The uterus is typically removed through the vaginal canal or via morcellation if needed. It’s a preferred method for many benign and some malignant gynecological conditions due to quicker recovery, less pain, and minimal scarring. 🛠️ Indications for TLH CategoryExamplesBenignFibroids (leiomyoma), adenomyosis, chronic pelvic pain, heavy menstrual bleeding, endometriosisPre-malignantComplex atypical hyperplasiaMalignant (select cases)Early endometrial cancer 🔍 Preoperative Evaluation Pelvic ultrasound or MRI Pap smear, endometrial biopsy CBC, coagulation profile, fitness for anesthesia Informed consent explaining risks, benefits, and possible need for open conversion 🔬 Procedure Steps (Simplified) Anesthesia & Positioning General anesthesia, lithotomy position with Trendelenburg tilt Port Placement Umbilical camera port + 2–3 accessory ports in lower abdomen CO₂ Insufflation To create pneumoperitoneum for visualization Dissection Uterine ligaments and blood supply (uterine arteries) are carefully sealed and cut Mobilization Bladder is dissected down, ureters are visualized and protected Uterus Removal Via vaginal canal if feasible or morcellated laparoscopically if large Vault Closure Vaginal cuff is sutured laparoscopically Final Check & Port Closure ⏱️ Surgical Duration Typically 1.5 to 3 hours, depending on case complexity ✅ Advantages of TLH Smaller incisions → minimal scarring Shorter hospital stay (often 1–2 days) Faster recovery (~2–4 weeks) Less postoperative pain Lower infection rates than abdominal hysterectomy Earlier return to normal activities ⚠️ Potential Complications TypeDetailsSurgicalBleeding, infection, injury to bladder, bowel, or ureterAnesthesia-relatedAspiration, reactions, airway issuesLateVaginal cuff dehiscence, hernia at port siteConversion to openIn cases of excessive bleeding, adhesions, large uterus 🏥 Postoperative Care Early ambulation (within 6–12 hrs) Resume light diet same day or next Pain management (oral NSAIDs or acetaminophen) Vaginal discharge for a few weeks (normal) No heavy lifting or intercourse for 6 weeks Wound care for port sites 📉 Recovery Timeline ActivityTimeframeDischarge1–2 days post-opResume light work2–3 weeksFull recovery4–6 weeksReturn to exercise/intercourse~6 weeks 📝 Patient Counseling Points TLH does not affect hormone levels unless ovaries are removed Menstruation stops permanently Discuss fertility implications before surgery Follow-up appointment typically in 1–2 weeks