Introduction

Total Laparoscopic Hysterectomy (TLH) has revolutionized gynecologic surgery by offering a minimally invasive option for removing the uterus while preserving the integrity of the abdominal wall. The introduction of innovative technologies, such as UKIT (Uterine-Kit Integrated Transillumination), has enhanced surgical visibility and safety, reducing complications and improving patient outcomes. This essay outlines a step-by-step surgical guide to TLH using UKIT illumination, highlighting procedural intricacies, advantages, and clinical implications.

Preoperative Preparation

Proper preoperative evaluation is crucial for the success of TLH. The patient should undergo:

Comprehensive history and physical examination
Pelvic ultrasound to assess uterine size and adnexal structures
Laboratory tests, including CBC, coagulation profile, and pre-anesthesia workup
Informed consent detailing the risks, benefits, and alternatives
Bowel preparation, if required, to optimize visualization
Prophylactic antibiotics administered 30–60 minutes before incision

The surgical team ensures availability of laparoscopic instruments, energy sources (bipolar or ultrasonic), uterine manipulator, and the UKIT illumination device.

Step-by-Step Surgical Procedure

1. Anesthesia and Positioning
The procedure begins under general anesthesia. The patient is placed in the dorsal lithotomy position with the arms tucked and in steep Trendelenburg to allow gravitational displacement of the bowel.

2. Insertion of Uterine Manipulator with UKIT Illumination
A key differentiator in this technique is the use of a uterine manipulator integrated with UKIT illumination. The device is inserted transvaginally into the uterine cavity and secured. UKIT provides a safe and consistent transillumination, clearly delineating anatomical landmarks such as the cervix, vaginal fornices, and ureters.

3. Port Placement and Pneumoperitoneum
A Veress needle or open (Hasson) technique is used to establish pneumoperitoneum. A 10-mm umbilical trocar is inserted for the laparoscope. Three accessory ports (5-mm) are placed under direct vision—typically one suprapubic and two lateral.

4. Inspection and Adhesiolysis
A thorough survey of the pelvis and abdomen is conducted. Adhesions, if present, are lysed to mobilize the uterus and adnexa.

5. Skeletonization and Sealing of Uterine Vessels
Using the UKIT illumination, the uterine vessels are visualized with greater clarity. The infundibulopelvic ligaments or utero-ovarian ligaments (depending on oophorectomy decision) are coagulated and transected. This is followed by ligation of the round ligaments.

6. Bladder Mobilization
The bladder flap is created by incising the vesicouterine peritoneum. With the cervix illuminated by UKIT, the dissection becomes safer, minimizing the risk of bladder injury.

7. Cardinal and Uterosacral Ligament Transection
These structures are carefully coagulated and divided. UKIT assists in visualizing the vaginal fornices, guiding precise dissection.

8. Colpotomy
Under the transilluminated guidance of UKIT, the vaginal cuff is incised circumferentially using monopolar energy or ultrasonic shears. The uterus is delivered vaginally or via morcellation if needed.

9. Vaginal Cuff Closure
The vaginal vault is sutured laparoscopically, typically using delayed absorbable barbed sutures. Proper approximation ensures hemostasis and minimizes vault prolapse risk.

10. Final Inspection and Port Closure
Hemostasis is confirmed throughout the pelvis. The ports are removed under direct vision. Fascia at the 10-mm port site is closed, and skin incisions are approximated.

Postoperative Management

Postoperative care includes monitoring vital signs, pain control, early ambulation, and a gradual return to normal activities. Most patients are discharged within 24 hours. Follow-up visits ensure proper healing and address any complications such as infection or vault dehiscence.

Advantages of TLH with UKIT Illumination

Enhanced Safety: Improved visualization of ureters and cervicovaginal junction reduces the risk of injury.
Precision: Illuminated guidance allows accurate colpotomy and dissection.
Efficiency: Shorter operative times and decreased blood loss due to targeted vessel sealing.
Training Aid: UKIT serves as a valuable educational tool for trainees learning anatomical orientation.

Conclusion

Total Laparoscopic Hysterectomy with UKIT illumination represents a significant advancement in gynecologic surgery. By integrating targeted transillumination into conventional TLH, surgeons can achieve superior anatomical clarity, enhancing safety and efficacy. As surgical technologies evolve, techniques like TLH with UKIT set a new standard for minimally invasive hysterectomy, offering tangible benefits for both patients and surgical teams.