This video demonstrates Total Laparoscopic Hysterectomy (TLH) with Infrared Ureteral Stent by Dr. R K Mishra at World Laparoscopy Hospital. IRIS U-Kits of stryker have Lighted ureteral stents which can be used in gynecological procedures. This Visualization technology built into the L10 Light Source is designed to help identify the ureters in lower pelvic procedures and reduce the risk of ureteral injury.

Hysterectomy, the surgical removal of the uterus, is one of the most common gynecological procedures worldwide. Traditionally performed via open abdominal or vaginal approaches, the advent of laparoscopy has revolutionized this surgery. Total Laparoscopic Hysterectomy (TLH) represents a minimally invasive technique that allows complete removal of the uterus, including the cervix, through small abdominal incisions.

Adding advanced technologies like infrared ureteral stents further enhances surgical safety, particularly in complex cases where ureteral injury is a risk.

What is Total Laparoscopic Hysterectomy (TLH)?

TLH is a minimally invasive procedure in which the entire uterus is removed using laparoscopic instruments. The surgeon operates through small incisions in the abdomen, using a camera (laparoscope) to visualize the pelvic organs on a monitor. TLH offers several benefits compared to traditional open surgery:

• Reduced postoperative pain

• Faster recovery and shorter hospital stay

• Minimal scarring

• Lower risk of infection and adhesions

Role of Infrared Ureteral Stents

One of the most serious complications in hysterectomy is ureteral injury, which can lead to long-term kidney damage if unrecognized. To mitigate this risk, surgeons now often use infrared ureteral stents. These are small, flexible tubes placed inside the ureters (the ducts connecting kidneys to the bladder) that fluoresce under near-infrared light.

Advantages of using infrared ureteral stents during TLH include:

1. Enhanced Ureteral Visualization – Surgeons can clearly see ureters in real time, reducing the risk of accidental injury.

2. Safety in Complex Cases – Especially useful in patients with previous pelvic surgery, large fibroids, or distorted anatomy.

3. Reduced Postoperative Complications – Early identification and protection of ureters lead to safer outcomes and faster recovery.

Step-by-Step TLH with Infrared Ureteral Stent

1. Preoperative Preparation – The patient undergoes routine blood tests, imaging, and anesthesia assessment. Ureteral stents are prepared for intraoperative placement.

2. Stent Placement – Under cystoscopic guidance, infrared stents are inserted into both ureters.

3. Laparoscopic Access – Small incisions are made in the abdomen, and trocars are inserted to allow the passage of the camera and surgical instruments.

4. Uterine Dissection – The uterus is carefully separated from surrounding tissues, with constant visualization of the ureters using infrared imaging.

5. Uterine Removal – The uterus is removed either intact or morcellated (if large) through the laparoscopic ports.

6. Closure and Recovery – The incisions are closed, and the patient is monitored in the recovery room. Infrared stents are usually removed at the end of surgery or a few days later, depending on the surgeon’s protocol.

Who Can Benefit from TLH with Infrared Ureteral Stents?

• Women with benign conditions such as fibroids, adenomyosis, or heavy menstrual bleeding unresponsive to medical treatment.

• Patients with endometriosis or pelvic adhesions where ureteral injury risk is higher.

• Women undergoing prophylactic hysterectomy for cancer risk reduction or treatment of early-stage gynecological malignancy.

Outcomes and Advantages

Studies have shown that TLH with infrared ureteral stent guidance is:

• Highly safe, with significantly lower rates of ureteral injury

• Minimally invasive, leading to reduced postoperative pain and faster recovery

• Cost-effective, by preventing complications that may require additional interventions

Conclusion

Total Laparoscopic Hysterectomy with infrared ureteral stents represents the forefront of safe, minimally invasive gynecological surgery. By combining laparoscopic precision with advanced ureteral visualization, this technique maximizes patient safety, reduces complications, and promotes faster recovery. Women requiring hysterectomy now have access to procedures that are not only effective but also significantly safer and more comfortable than traditional surgery.