This video demonstrate Total Laparoscopic Hysterectomy step by step using infrared ureter stent together with appendectomy. Combination procedure is very easy to perform by laparoscopy. Laparoscopic Hysterectomy remains a reasonable substitute for abdominal hysterectomy. Laparoscopic hysterectomy together with appendectomy is a cost-effective procedure when done with reusable instruments. Laparoscopic hysterectomy with ureteric stenting with infrared catheter is a safe procedure, even when performed by a variety of gynecologists with different skill levels, and its adoption can decrease abdominal incision hysterectomies.

Laparoscopic surgery has revolutionized the field of minimally invasive gynecological and general surgery. Combining procedures like hysterectomy and appendectomy in a single session can be challenging due to the close proximity of pelvic and abdominal structures. The use of an illuminated ureteral stent significantly enhances safety by clearly delineating the ureters, reducing the risk of injury during surgery. This article provides a step-by-step demonstration of laparoscopic hysterectomy and appendectomy with the aid of an illuminated ureteral stent.

Laparoscopic hysterectomy is a common procedure for managing conditions such as fibroids, adenomyosis, abnormal uterine bleeding, and malignancies. Appendectomy is often performed for acute or chronic appendicitis. Performing these surgeries simultaneously requires meticulous planning to avoid complications. The illuminated ureteral stent acts as a guide, allowing surgeons to identify and protect the ureters while operating in the pelvic region.

Preoperative Preparation

Patient Evaluation:

Complete history, physical examination, and relevant imaging studies.

Pre-anesthetic assessment.

Bowel Preparation:

Ensures a clear operative field, especially for appendectomy.

Informed Consent:

Discuss the combined procedure, potential risks, benefits, and alternatives with the patient.

Equipment Required

Laparoscopic tower with high-definition camera

Standard laparoscopic instruments (grasper, scissors, bipolar, suction)

Illuminated ureteral stent

Laparoscopic suturing devices

Energy devices for dissection (ultrasonic or advanced bipolar)

Surgical Technique: Step-by-Step
Step 1: Patient Positioning

Position the patient in a dorsal lithotomy position with a slight Trendelenburg tilt to optimize pelvic access.

Ensure padding of pressure points.

Step 2: Port Placement

Insert a 10 mm umbilical port for the camera.

Place two 5 mm ports in the lower quadrants and an additional 5 mm suprapubic port for instrumentation.

Step 3: Insertion of Illuminated Ureteral Stent

Cystoscopy is performed to place the illuminated ureteral stent in both ureters.

The stent lights up the ureters during dissection, providing visual guidance and minimizing injury risk.

Step 4: Laparoscopic Hysterectomy

Uterine Mobilization:

Dissect the bladder flap and mobilize the uterus.

Ligating Uterine Vessels:

Identify the illuminated ureters.

Secure uterine arteries close to the uterus while avoiding ureteral injury.

Colpotomy and Specimen Removal:

Perform circumferential colpotomy and remove the uterus vaginally or via morcellation.

Step 5: Laparoscopic Appendectomy

Appendix Identification:

Shift attention to the right lower quadrant.

Mesappendix Dissection:

Use energy devices to carefully dissect and control appendiceal vessels.

Appendix Removal:

Transect the appendix and retrieve it in an endoscopic bag.

Step 6: Hemostasis and Closure

Verify hemostasis throughout the operative field.

Remove ports and close fascia at the 10 mm port site.

Close skin incisions with absorbable sutures.

Postoperative Care

Monitor vital signs, urine output, and abdominal pain.

Early ambulation to prevent thromboembolism.

Gradual reintroduction of diet.

Discharge usually within 24–48 hours if recovery is smooth.

Advantages of Using Illuminated Ureteral Stent

Reduces risk of ureteral injury during pelvic surgery.

Improves surgeon confidence in complex combined procedures.

Provides real-time ureteral visualization, especially in distorted anatomy or adhesions.

Conclusion

The combination of laparoscopic hysterectomy and appendectomy using an illuminated ureteral stent is a safe and effective approach in selected patients. This technique enhances surgical safety, reduces operative complications, and demonstrates the growing role of advanced technology in minimally invasive surgery. Step-by-step demonstration videos further aid in surgical education, allowing trainees and practicing surgeons to understand and adopt these innovative approaches.