This video demonstrates TLH with BSO by Dr. R K Mishra at World Laparoscopy Hospital. The use of laparoscopic hysterectomy has recently been reported as an alternative to traditional abdominal hysterectomy and the utilization of a mini-endoscopic technique has also been recorded. This prospective randomized study has demonstrated that after laparoscopic hysterectomy, patients recovered more quickly and had less pain, and the incidence of complications was also low. One serious complication after laparoscopic hysterectomy is increased ureteric injury, but in our opinion, it is possible to avoid major complications by paying particular attention to the surgical details.

Total Laparoscopic Hysterectomy with Bilateral Salpingo-Oophorectomy (TLH with BSO) is a minimally invasive surgical procedure performed to remove the uterus, both fallopian tubes, and both ovaries. This procedure is commonly indicated for various gynecological conditions such as uterine fibroids, endometriosis, chronic pelvic pain, abnormal uterine bleeding, ovarian cysts, or risk reduction in patients with a high risk of ovarian and breast cancer.

What is TLH with BSO?

• Total Laparoscopic Hysterectomy (TLH): This involves the complete removal of the uterus through small laparoscopic incisions in the abdomen.

• Bilateral Salpingo-Oophorectomy (BSO): This involves the removal of both fallopian tubes (salpingectomy) and both ovaries (oophorectomy).

Together, this procedure helps in eliminating the source of gynecological diseases while reducing future risks associated with ovarian and uterine malignancies.

Indications

TLH with BSO is typically recommended in the following situations:

1. Benign gynecological conditions:

   • Large fibroids causing pain or bleeding.

   • Endometriosis unresponsive to medication.

   • Chronic pelvic inflammatory disease.

2. Malignancy prevention:

   • Women with BRCA1 or BRCA2 gene mutations.

3. Cancer treatment:

   • Early-stage ovarian, uterine, or fallopian tube cancers.

4. Severe pelvic pain or bleeding:
   When conservative treatment options fail.

Advantages of Laparoscopic Approach

Compared to traditional open surgery (abdominal hysterectomy), TLH with BSO offers:

• Minimally invasive: Small incisions, typically 0.5–1 cm in size.

• Faster recovery: Patients often return home within 24–48 hours.

• Reduced pain: Postoperative pain is significantly less.

• Minimal scarring: Cosmetic advantage due to smaller scars.

• Lower risk of infection: Less exposure and tissue handling.

• Early return to daily activities: Usually within 1–2 weeks.

Procedure Overview

1. Anesthesia: General anesthesia is administered.

2. Incision: Several small incisions are made in the abdomen.

3. Insertion of laparoscope: A camera and surgical instruments are inserted through these incisions.

4. Uterus removal: The uterus is carefully separated from surrounding tissues.

5. Bilateral salpingo-oophorectomy: Both ovaries and fallopian tubes are removed.

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

7. Recovery: Patients are monitored briefly in the hospital before discharge.

Recovery and Postoperative Care

• Hospital stay: Usually 1–2 days.

• Activity: Light activity can begin within a few days; heavy lifting is avoided for 4–6 weeks.

• Pain management: Mild pain is managed with prescribed analgesics.

• Follow-up: Routine follow-up visits to monitor healing and overall health.

• Hormonal considerations: Removal of ovaries leads to surgical menopause; hormone replacement therapy (HRT) may be considered if appropriate.

Risks and Complications

Although TLH with BSO is generally safe, possible complications include:

• Bleeding

• Infection

• Injury to bladder, ureters, or bowel

• Adhesion formation

• Early onset menopause and related symptoms

Conclusion

Total Laparoscopic Hysterectomy with Bilateral Salpingo-Oophorectomy is a safe and effective surgical option for women with gynecological conditions requiring removal of the uterus and ovaries. The minimally invasive laparoscopic approach ensures faster recovery, reduced pain, and better cosmetic outcomes, making it the preferred choice for both patients and surgeons worldwide.