This video demonstrates Skin to Skin Total Laparoscopic Hysterectomy with Infrared Ureteric Stent performed by Dr R K Mishra at World Laparoscopy Hospital. This is a must-watch video for everyone to see how nicely illuminated stent look. Despite the skepticism, potential advantages afforded by this minimal access technique motivated the development and evaluation of the laparoscope in an expanding number of surgical applications. Numerous technologic advances were critical to this evolution. During the first half of this century, the development of various lens systems and endoscopes was there. Recently use of Infrared imaging systems in laparoscopy has revolutionized the way how we were looking at ureter in the past. The infrared lighted ureteral stent or ureteric stent is a thin tube inserted into the ureter to prevent or treat an obstruction of the urine flow from the kidney. The length of the stents used in adult patients varies between 24 and 30 cm.

Total Laparoscopic Hysterectomy (TLH) has become the gold standard for the surgical management of benign and selected malignant gynecological conditions. Over recent years, advances in surgical technology, including the use of infrared ureteric stents, have significantly enhanced patient safety and surgical precision. A skin-to-skin approach in TLH ensures minimally invasive access, reduced postoperative pain, and faster recovery.

Preoperative Preparation

Preoperative assessment is crucial to optimize patient outcomes. This includes a thorough gynecological examination, imaging studies, and evaluation of comorbidities. The placement of an infrared ureteric stent preoperatively allows real-time visualization of the ureters during surgery, reducing the risk of inadvertent ureteric injury, which is one of the most feared complications in pelvic surgery.

Surgical Technique

1. Patient Positioning and Anesthesia

   • The patient is placed in a dorsal lithotomy position.

   • General anesthesia is administered, and prophylactic antibiotics are given.

2. Port Placement (Skin-to-Skin Approach)

   • A small infraumbilical incision is made for the primary laparoscopic port.

   • Additional ports are placed under direct visualization, maintaining minimal skin incisions while providing optimal access to the pelvic cavity.

3. Infrared Ureteric Stent Visualization

   • Bilateral ureteric stents with infrared markers are inserted cystoscopically.

   • The laparoscopic camera with infrared capability identifies the ureters, allowing the surgeon to avoid injury while dissecting around critical structures.

4. Dissection and Hysterectomy

   • The round ligaments, broad ligaments, and uterine vessels are carefully dissected.

   • The uterus is mobilized and detached from the vaginal cuff laparoscopically.

   • Infrared guidance ensures ureters are preserved throughout.

5. Specimen Retrieval and Closure

   • The uterus is removed through a minimally invasive incision or via the vagina if indicated.

   • The vaginal cuff is closed laparoscopically.

   • Ports are removed, and skin incisions are closed in a cosmetically favorable manner.

Advantages of Skin-to-Skin TLH with Infrared Ureteric Stent

• Enhanced Safety: Real-time ureteric visualization reduces the risk of injury.

• Minimally Invasive: Smaller incisions lead to less pain, faster recovery, and minimal scarring.

• Precision Surgery: Infrared guidance allows for meticulous dissection near critical structures.

• Reduced Complications: Improved identification of ureters and vessels lowers intraoperative and postoperative complications.

Postoperative Care
Patients are typically discharged within 24–48 hours. Postoperative pain is managed with oral analgesics, and early ambulation is encouraged. Follow-up imaging is not routinely required unless complications arise.

Conclusion
Skin-to-skin Total Laparoscopic Hysterectomy with infrared ureteric stents represents a cutting-edge, minimally invasive approach in modern gynecologic surgery. It combines the advantages of laparoscopic hysterectomy with enhanced ureteral safety, reduced recovery time, and excellent cosmetic outcomes, making it a preferred choice for both patients and surgeons.