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This Video demonstrates TLH with Mishra Knot and Simple Bipolar with Three Port. The simple bipolar system has some advantages and is cost-effective over the conventional ligasure or harmonic scalpel system, and therefore, may offer an alternative option for patients undergoing TLH. Ligation of a uterine artery by Mishra's knot is very effective and it will prevent ureteric injury. in TLH once in the operating room, you will receive either spinal and/or general anesthesia before the surgery to keep you from feeling pain.

The choice of anesthesia is a decision that will be made by anesthesia based on your history and your wishes. If you receive general anesthesia after you are asleep and before the surgery starts: a tube to help you breathe will be placed in your throat. After a Total Laparoscopic Hysterectomy patient will be discharged either the same day or the very next day of surgery. Laparoscopic hysterectomies have been clearly associated with decreased blood loss, shorter hospital stay, speedier return to normal activities, and fewer abdominal wall infections when compared with abdominal hysterectomies. Total laparoscopic hysterectomy is a safe and effective procedure for women needing a hysterectomy. We enjoy a high operative volume and perform approximately 300 laparoscopic hysterectomy cases annually with a conversion rate of 1 in every 500 cases. The steps described herein in this video are not meant to be an absolute truth, but rather a true and tested method that has served us well to safely accomplish this procedure.

Learn the step-by-step technique of Total Laparoscopic Hysterectomy (TLH) using the Mishra Knot and Simple Bipolar method with a three-port approach. This surgical video, demonstrated by expert laparoscopic surgeons, focuses on safe, efficient, and minimally invasive hysterectomy techniques, highlighting precision, hemostasis, and reduced operative time.

Whether you are a gynecologist, surgical trainee, or medical student, this video offers valuable insights into modern laparoscopic procedures and advanced suturing techniques.

Total Laparoscopic Hysterectomy (TLH) is a minimally invasive surgical procedure for the removal of the uterus. Over the years, TLH has gained popularity due to its advantages over traditional open surgery, including reduced blood loss, minimal postoperative pain, shorter hospital stay, and faster recovery.

The Three-Port Technique, combined with advanced suturing methods like the Mishra Knot and hemostasis using Simple Bipolar, has further improved the safety and efficiency of TLH.

What is TLH?

TLH is a laparoscopic procedure in which the uterus is completely removed through small abdominal incisions with the help of a laparoscope and specialized instruments. Unlike subtotal hysterectomy, TLH involves removal of the cervix along with the uterus.

Indications:

Uterine fibroids

Adenomyosis

Abnormal uterine bleeding

Endometrial hyperplasia

Early-stage endometrial cancer

Three-Port Technique

The Three-Port TLH is a minimally invasive approach that uses only three small incisions:

Umbilical port – for the laparoscope.

Left lateral port – for primary surgical instruments.

Right lateral port – for assistance and manipulation.

This approach provides excellent visualization and access to the pelvic structures while minimizing trauma and improving cosmetic outcomes.

Mishra Knot in TLH

The Mishra Knot is an advanced laparoscopic suturing technique that allows secure and efficient closure of the vaginal cuff after uterus removal. Key benefits include:

Strong and reliable knot security

Reduced operative time

Easy to learn for surgeons with basic laparoscopic skills

Minimizes risk of postoperative vaginal cuff dehiscence

Simple Bipolar for Hemostasis

Simple Bipolar coagulation is used during TLH to control bleeding from blood vessels and the uterine pedicles. Advantages include:

Precise coagulation with minimal tissue damage

Reduced risk of thermal spread

Better visualization of surgical field

Enhanced safety during dissection

Step-by-Step Procedure

Patient Preparation – Under general anesthesia, the patient is positioned in lithotomy.

Port Placement – Umbilical and two lateral ports are inserted.

Uterine Mobilization – Ligaments, vessels, and surrounding structures are carefully dissected.

Hemostasis – Simple bipolar coagulation is applied to major vessels.

Uterine Removal – The uterus is detached and removed through the vaginal canal or morcellation if required.

Vaginal Cuff Closure – Mishra Knot technique is used to close the cuff securely.

Final Check – Hemostasis is verified, and ports are removed.

Advantages of TLH with Mishra Knot and Simple Bipolar

Minimally invasive with small scars

Reduced intraoperative blood loss

Secure vaginal cuff closure

Shorter operative time

Faster recovery and early return to normal activities

Conclusion

Total Laparoscopic Hysterectomy using the Three-Port Technique with Mishra Knot and Simple Bipolar coagulation represents a safe, efficient, and advanced approach to uterine removal. This technique combines minimal invasiveness, precise suturing, and excellent hemostasis, making it a preferred choice for gynecologic surgeons worldwide.

For gynecologists, surgical trainees, and medical students, mastering this approach is essential for improving patient outcomes and advancing minimally invasive surgical skills.

For more information: World Laparoscopy Hospital Cyber City, Gurugram, NCR Delhi INDIA Phone: +919811416838