This video demonstrates Total Laparoscopic Hysterectomy by Myoma Screw Without Uterine Manipulator. In this technique, the uterus was bound from the uterine corpus and fundus like a bridle with Myoma Screw, to allow abdominal manipulation. The technique was successfully performed at the first attempt in 90% of cases. The mean application time was 30 min. The vaginal manipulator was not required in any of the cases. There were no intraoperative complications. In conclusion, this method has the advantages of not requiring any vaginal manipulator, reducing the number of people required during operation, permitting a near-maximum manipulation of the uterus in all three dimensions, and giving the control.
Total Laparoscopic Hysterectomy by Myoma Screw Without Uterine Manipulator at World Laparoscopy Hospital
Total Laparoscopic Hysterectomy (TLH) is one of the most advanced and widely practiced minimally invasive procedures for the removal of the uterus. With continuous innovations in laparoscopic techniques, surgeons are constantly developing safer and more efficient methods to perform hysterectomy. At World Laparoscopy Hospital, a globally recognized institute for minimal access surgery training, a unique and effective technique—Total Laparoscopic Hysterectomy using a Myoma Screw without a uterine manipulator—has gained attention for its simplicity, safety, and practicality.
Traditionally, a uterine manipulator is used during laparoscopic hysterectomy to mobilize and position the uterus for better visualization and dissection. However, in certain clinical situations such as cervical stenosis, large fibroids, vaginal scarring, or when a manipulator is not available, alternative methods become necessary. The use of a myoma screw as a uterine handling tool provides an excellent solution in these cases. This technique allows surgeons to achieve effective uterine traction and counter-traction without relying on a vaginal manipulator.
At World Laparoscopy Hospital, surgeons and trainees learn how to safely perform TLH using this innovative approach. In this method, a myoma screw is inserted laparoscopically into the uterine fundus. The screw acts as a strong handle, enabling the surgeon to manipulate the uterus in different directions such as elevation, lateral movement, and rotation. This controlled manipulation improves exposure of vital structures including the uterine vessels, bladder, and ureters, which is essential for safe dissection.
The surgical steps remain similar to standard TLH procedures. After establishing pneumoperitoneum and placing laparoscopic ports, the myoma screw is introduced to grasp the uterus. The round ligaments, fallopian tubes, and ovarian ligaments are coagulated and divided. Careful bladder dissection is performed to push the bladder away from the cervix. The uterine vessels are then skeletonized, coagulated, and cut. Circumferential colpotomy is carried out laparoscopically, and the uterus is removed either vaginally or through morcellation when required. Finally, the vaginal vault is closed laparoscopically.
One of the major advantages of this technique is simplicity and reduced dependence on specialized instruments. In many resource-limited settings, a uterine manipulator may not be readily available. Using a myoma screw provides a cost-effective alternative while maintaining surgical safety. Additionally, it eliminates the need for vaginal instrumentation, which can be beneficial in patients with narrow vagina, previous vaginal surgery, or infection.
Training at World Laparoscopy Hospital focuses heavily on hands-on learning and practical exposure. Under the mentorship of experienced laparoscopic surgeons, doctors from around the world gain confidence in performing complex procedures like TLH using innovative techniques. The hospital is known for integrating modern technology, structured training programs, and live surgical demonstrations that help surgeons master advanced minimally invasive procedures.
Another important benefit of this approach is improved ergonomics for the surgeon. The myoma screw provides a firm and stable grip on the uterus, allowing precise traction and counter-traction during critical steps of the surgery. This control helps maintain a clear surgical field and reduces the risk of injury to nearby structures such as the ureters and bladder.
Patients also benefit greatly from laparoscopic hysterectomy techniques taught at World Laparoscopy Hospital. Compared with open surgery, TLH offers smaller incisions, reduced blood loss, less postoperative pain, shorter hospital stay, and faster recovery. These advantages make minimally invasive surgery the preferred choice for many gynecological conditions requiring hysterectomy.
In conclusion, Total Laparoscopic Hysterectomy by Myoma Screw without a uterine manipulator represents an innovative and practical advancement in minimally invasive gynecologic surgery. The technique demonstrates that with proper surgical skill and understanding of anatomy, complex procedures can be performed safely even without conventional instruments. Through comprehensive training and global education programs, World Laparoscopy Hospital continues to empower surgeons with modern surgical skills, ultimately improving patient care and advancing the field of laparoscopic surgery worldwide.
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