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Advanced Laparoscopic Hysterectomy: TLH and BSO Using ICG - A Tutorial
Gnae / Dec 21st, 2023 1:13 pm     A+ | a-

Advanced Laparoscopic Hysterectomy: A Comprehensive Guide to TLH and BSO with ICG Guidance

Laparoscopic hysterectomy, a minimally invasive surgical procedure for the removal of the uterus, has evolved significantly over the years. Incorporating advanced techniques like Total Laparoscopic Hysterectomy (TLH) and Bilateral Salpingo-Oophorectomy (BSO) with Indocyanine Green (ICG) fluorescence imaging, this procedure marks a new era in gynecological surgeries. This comprehensive guide explores the intricacies of TLH and BSO with ICG guidance, offering insights into its application, benefits, and the future of laparoscopic hysterectomy.

Understanding the Techniques

Total Laparoscopic Hysterectomy (TLH): TLH involves the complete removal of the uterus laparoscopically. This procedure is favored for its minimal invasiveness compared to traditional open hysterectomy.

Bilateral Salpingo-Oophorectomy (BSO): BSO is the removal of both fallopian tubes and ovaries. It's often performed in conjunction with TLH, especially in cases where there's a risk of ovarian cancer or other pelvic pathologies.

Indocyanine Green (ICG) Fluorescence Imaging: ICG is a medical dye used in fluorescence imaging during surgery. When illuminated with near-infrared light, ICG emits fluorescence, providing surgeons with enhanced visualization of blood flow and tissue perfusion. This technology is particularly useful in identifying critical structures like blood vessels and ureters during surgery.

The Procedure: Step-by-Step

1. Preoperative Preparation: Patient evaluation, including medical history and imaging studies, is crucial. The use of ICG should be discussed with the patient, considering any allergies or contraindications.

2. Anesthesia and Positioning: General anesthesia is administered. The patient is positioned to allow optimal access to the pelvic region.

3. Creating the Pneumoperitoneum: Small incisions are made for the insertion of the laparoscope and surgical instruments. Carbon dioxide gas is used to inflate the abdomen, providing a better view of the internal organs.

4. Application of ICG: ICG is injected intravenously. The surgeon uses a specialized camera to visualize the enhanced fluorescence, aiding in the identification of anatomical structures.

5. Performing TLH and BSO: The uterus, along with the fallopian tubes and ovaries (in case of BSO), is carefully detached from surrounding tissues and removed through one of the incisions.

6. Closure: The incisions are closed with sutures or surgical glue.

Advantages of TLH and BSO with ICG

- Enhanced Visualization: ICG provides real-time, high-definition imaging of blood vessels and organs, reducing the risk of inadvertent injury.

- Precision and Safety: The accuracy in identifying and preserving essential structures like the ureter and blood vessels is significantly improved.

- Reduced Complication Rates: The precise technique leads to fewer complications like blood loss or damage to surrounding tissues.

- Faster Recovery: Minimally invasive approach results in shorter hospital stays and quicker return to normal activities.

Challenges and Considerations

The use of ICG and laparoscopic techniques requires specialized training and experience. There is a learning curve associated with mastering these advanced procedures. Patient selection and thorough preoperative assessment are critical for successful outcomes.

The Future of Laparoscopic Hysterectomy

The integration of ICG in laparoscopic hysterectomy is just the beginning. The future may see the incorporation of more advanced imaging techniques and possibly robotic assistance, further enhancing the safety and efficacy of these procedures.


Advanced laparoscopic hysterectomy using TLH and BSO with ICG guidance represents a significant leap in gynecological surgery. It offers a safer, more precise, and less invasive option for patients, showcasing the remarkable progress in surgical technologies and techniques. As these methods continue to evolve, they hold the promise of even better patient outcomes and a new standard in surgical care.
Dr. Akshara Patel
May 20th, 2024 6:43 pm
Laparoscopic hysterectomy, propelled by innovations like TLH and BSO with ICG guidance, reshapes gynecological surgery. This guide navigates through the intricacies, underscoring its transformative impact.

TLH and BSO with ICG offer unparalleled precision and safety, revolutionizing visualization and reducing complications. Their advantages, from enhanced blood flow imaging to faster recovery, redefine patient care.

However, mastering these techniques demands specialized training and careful patient selection. The evolving landscape hints at even greater advancements, including robotic assistance and advanced imaging modalities, promising safer and more efficient procedures.

As we embrace this new era, laparoscopic hysterectomy emerges not just as a surgical procedure but as a testament to the relentless pursuit of excellence in women's health care.

Dr. Alok Gupta
May 26th, 2024 9:32 am
Laparoscopic hysterectomy has undergone remarkable advancements with the integration of Total Laparoscopic Hysterectomy (TLH) and Bilateral Salpingo-Oophorectomy (BSO) guided by Indocyanine Green (ICG) fluorescence imaging. This transformative approach not only offers enhanced visualization but also ensures precision and safety in gynecological surgeries.

The step-by-step guide provides a comprehensive understanding of TLH and BSO with ICG, highlighting their application and benefits. From preoperative preparation to closure, each stage emphasizes meticulous technique and patient-centric care. The advantages, including reduced complication rates and faster recovery, underscore the significance of this approach in improving patient outcomes.

However, mastering these advanced techniques requires specialized training and experience. Surgeons must navigate the learning curve and carefully select appropriate candidates for surgery. Looking ahead, the future of laparoscopic hysterectomy holds promise with the potential integration of more sophisticated imaging modalities and robotic assistance, paving the way for further advancements in minimally invasive gynecological surgery.
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