This video demonstrates Total Laparoscopic Hysterectomy (TLH) with Bilateral Salpingo-oophorectomy (BSO)Traditionally standard treatment for patients with the uterine disease is a total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH+BSO) with or without lymph node dissection through a vertical midline incision. While TAH is an accepted effective treatment, it is highly invasive, visibly scarring, and associated with morbidity. An alternative treatment is the same operation by laparoscopic hysterectomy with bilateral salpingo-oophorectomy. Though in several studies total laparoscopic hysterectomy (TLH+ BSO) seems a safe and feasible alternative approach in early-stage endometrial cancer patients, there are no randomized data available yet. Furthermore, a randomized controlled trial with surgeons trained in laparoscopy is warranted in order to implement this technique in a safe manner.

Total Laparoscopic Hysterectomy (TLH) with Bilateral Salpingo-Oophorectomy (BSO) is one of the most advanced minimally invasive gynecological procedures used for the treatment of various benign and malignant uterine and ovarian conditions. The procedure involves laparoscopic removal of the uterus, cervix, both fallopian tubes, and both ovaries through small abdominal incisions. Compared to traditional open surgery, this technique offers superior patient outcomes, faster recovery, and improved surgical precision.

At World Laparoscopy Hospital (WLH), this procedure is performed and taught as part of world-class minimally invasive surgical care and training programs. WLH is internationally recognized as a center of excellence providing advanced laparoscopic, endoscopic, and robotic surgery training along with high-quality patient care.

Understanding TLH with BSO

A TLH with BSO combines two major surgical components:

• Total Laparoscopic Hysterectomy (TLH): Removal of uterus and cervix using laparoscopic instruments.

• Bilateral Salpingo-Oophorectomy (BSO): Removal of both fallopian tubes and ovaries.

After this surgery, the patient cannot conceive and typically enters menopause if ovaries are removed before natural menopause.

Surgical Technique Overview

During TLH with BSO:

1. Small keyhole incisions are made in the abdomen.

2. A laparoscope (camera with fiber-optic light) is inserted to visualize pelvic organs.

3. Specialized instruments are introduced through other ports.

4. Uterine supporting ligaments are divided.

5. Uterus is removed safely, often in small pieces.

6. Fallopian tubes and ovaries are detached and removed.

The use of devices like uterine manipulators helps improve surgical access and precision during the procedure.

Advantages of TLH with BSO

Modern evidence strongly supports laparoscopic hysterectomy over open surgery due to multiple benefits:

• Less blood loss

• Less postoperative pain

• Reduced complications

• Faster recovery and return to daily activities

• Shorter hospital stay

• Better cosmetic outcome

These benefits have been consistently documented in laparoscopic hysterectomy programs worldwide.

Clinical Indications

TLH with BSO is commonly performed for:

• Endometrial cancer

• Ovarian tumors or cysts

• Severe endometriosis

• Chronic pelvic pain

• Large fibroids

• Genetic cancer risk reduction (e.g., BRCA mutation)

In cancer care, laparoscopic approaches have shown similar oncologic safety with improved recovery compared to open surgery in selected cases.

Recovery After Surgery

Patients undergoing TLH with BSO generally experience faster recovery compared to abdominal hysterectomy.

Typical postoperative course may include:

• Mild abdominal discomfort

• Shoulder or back pain due to surgical gas

• Vaginal discharge for few weeks

• Activity restriction for 4–6 weeks

Most patients resume normal activities earlier than with open surgery.

Risks and Possible Complications

Although safe, potential risks include:

• Infection

• Bleeding

• Blood clots

• Emotional or hormonal changes (due to surgical menopause)

Major complications are uncommon but possible with any major surgery.

Role of World Laparoscopy Hospital

World Laparoscopy Hospital plays a significant role in advancing minimally invasive gynecologic surgery through:

• Advanced laparoscopic surgical treatment

• Hands-on training and live surgical demonstrations

• Research and academic programs

• Global surgeon training and collaboration

The institute follows the philosophy of “Skilled Surgeon Safer Surgery,” ensuring high-quality outcomes and patient safety.

Why TLH with BSO at WLH is Unique

At WLH, procedures are performed with:

• Latest laparoscopic technology

• Standardized surgical protocols

• Highly experienced laparoscopic surgeons

• Academic and evidence-based surgical practice

• Integrated training and patient care environment

This combination makes WLH a preferred destination for both surgical treatment and advanced training in minimally access gynecology.

Conclusion

Total Laparoscopic Hysterectomy with Bilateral Salpingo-Oophorectomy represents a milestone in modern gynecologic surgery. By combining minimal invasiveness with high surgical precision, it ensures better patient comfort, faster recovery, and improved clinical outcomes.