https://www.laparoscopyhospital.com
Total Laparoscopic Hysterectomy (TLH) by Three Port and Infrared Ureteric Catheter is the most common major gynecological procedure in women and minimally invasive approaches should be used wherever possible; total laparoscopic hysterectomy (TLH) is one such surgical approach that allows removal of the uterus entirely laparoscopically. However, the lack of surgical training opportunities is impeding its increased adoption. This video will formally test a surgical outreach training model to equip surgeons with the skills to provide TLH as an alternative to total abdominal hysterectomy (TAH).

Total Laparoscopic Hysterectomy (TLH) is one of the most advanced minimally invasive gynecological procedures used for removal of the uterus. The three-port TLH technique combined with the use of an infrared ureteric catheter represents a significant evolution in surgical safety, ergonomics, and cosmetic outcomes. This approach is increasingly adopted in high-volume laparoscopic training and surgical centers due to its precision and reduced postoperative morbidity.

The three-port technique involves the use of one umbilical camera port and two accessory working ports, minimizing abdominal wall trauma while maintaining optimal triangulation. Compared to conventional four-port hysterectomy, the three-port method reduces postoperative pain, improves cosmetic results, and shortens recovery time. The surgeon performs dissection, coagulation, and suturing efficiently through these limited ports using advanced energy devices and laparoscopic instruments.

A major concern during hysterectomy is ureteric injury, especially during uterine artery ligation and cardinal ligament dissection. The use of an infrared ureteric catheter significantly enhances intraoperative ureter visualization. When viewed under near-infrared imaging, the catheter emits fluorescence, allowing real-time identification of ureteric course even in distorted pelvic anatomy, large uterus, endometriosis, or previous surgery cases. This technology reduces the risk of ureteric damage and increases surgeon confidence during deep pelvic dissection.

The procedure typically begins with diagnostic laparoscopy and evaluation of pelvic anatomy. After port placement, the round ligaments are coagulated and cut, followed by opening of the broad ligament and bladder dissection. The uterine vessels are skeletonized and sealed carefully with continuous monitoring of ureteric position using infrared guidance. Colpotomy is then performed circumferentially, and the uterus is removed vaginally or via morcellation if required. The vaginal cuff is closed laparoscopically with intracorporeal suturing.

Advantages of TLH by three-port with infrared ureteric catheter include reduced operative complications, better ureteric safety, minimal blood loss, shorter hospital stay, faster return to daily activity, and excellent cosmetic results. It is particularly beneficial in complex hysterectomy cases where ureter identification may be challenging.

Training in this advanced technique requires strong fundamentals in laparoscopic suturing, pelvic anatomy, and energy device handling. High-volume training centers emphasize simulation-based learning, stepwise surgical exposure, and mentorship to ensure safe adoption of this technology.

In conclusion, three-port TLH with infrared ureteric catheter represents a modern advancement in minimally invasive gynecologic surgery. It enhances surgical safety while maintaining the principles of minimal access surgery, ultimately improving patient outcomes and expanding the boundaries of laparoscopic hysterectomy.