CONSEPT OF TLH
PRE-OPERATIVE PREPARATION AND ANESTHESIA
TECHNIQUE OF TLH
ADVANTAGES OF TLH
MYTHS ABOUT TLH
TOTAL LAPAROSCOPIC HYSTERECTOMY
As you would all agree that changing trends is the way for Life. Long back the conventional phone was the best way of communication for all of us, but with the advent of mobile phone it seems to become obsolete. Similarly for Hysterectomy, before abdominal and vaginal route were enough to tackle all our cases. But with changing trends and the advent of minimally invasive surgery TLH is the need for today. May be in future it will replace the conventional methods.
Who decides the route for hysterectomy? The patient, the relatives or the doctor? Ofcource the doctor, so as to give best options to the patient.
Since the first hysterectomy was performed by Reich in 1989, laparoscopy has been gaining wide acceptance as the approach route for hysterectomy in 2007. So let us know more about TLH.What is the global verses Indian scenario? In Europe and us more then 80% of the surgeries are done laparoscopically. We are also not lagging far behind in this respect. According to Dr Vivek Marwah laparoscopic surgeries will replace conventional in five to ten years.
Initially LAVH was the preferred method, where in very few steps were performed laparoscopically and rest was performed vaginally. So the approach was mainly to convert an AH to VH. Only ovarian and round ligament and infundibulopelvic ligament was done laparoscopically. Rest of the steps were done vaginally. So it was basically three step procedure 1st laparoscopic, 2nd vaginal and 3rd again laparoscopic for final irrigation and lavage. This required frequent change of position from modified lithotomy to lithotomy and again to modified lithotomy.
Gradually with the advent of more advanced technologies laparoscopic hysterectomy (LH) came into existence. The sine qua non of LH is laparoscopic ligation of uterine arteries. Rest of the steps are carried out vaginally.
With better understanding of laparoscopic pelvic anatomy and realizing the need of tackling associated pathologies total laparoscopic hysterectomy came in to picture. In TLH all steps of hysterectomy are accomplished laparoscopically, only extraction of uterus is done vaginally. As TLH mimics abdominal hysterectomy in almost all respects, it should be easy to assimilate it into practice for majority of patients.