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This video demonstrates a Hysterectomy for Multiple Fibroid by Dr. R K Mishra at World Laparoscopy Hospital. TLH is performed for this patient. Hysterectomy is a major surgical procedure in which the uterus and possibly the ovaries, fallopian tubes, and cervix are removed.

In Total Laparoscopic Hysterectomy, the surgeon performs most of the procedure through 3 small abdominal incisions aided by long, thin surgical instruments inserted through the incisions. Your surgeon then removes the uterus through an incision made in your vagina or in the case of laThere are various types of hysterectomy. The type you have depends on why you need the operation and how much of your womb and surrounding reproductive system can safely be left in place.

The main types of hysterectomy are:

total hysterectomy – the womb and cervix (neck of the womb) are removed; this is the most commonly performed operation
subtotal hysterectomy – the main body of the womb is removed, leaving the cervix in place
total hysterectomy with bilateral salpingo-oophorectomy – the womb, cervix, fallopian tubes (salpingectomy) and ovaries (oophorectomy) are removed
radical hysterectomy – the womb and surrounding tissues are removed, including the fallopian tubes, part of the vagina, ovaries, lymph glands and fatty tissue
There are 3 ways to carry out a hysterectomy:

laparoscopic hysterectomy (keyhole surgery) – where the womb is removed through several small cuts in the tummy
vaginal hysterectomy – where the womb is removed through a cut in the top of the vagina
abdominal hysterectomy – where the womb is removed through a cut in the lower tummy
Find out how a hysterectomy is performed

Complications of a hysterectomy
There's a small risk of complications, including:

heavy bleeding
infection
damage to your bladder or bowel
a serious reaction to the general anaestheticrge fibroid morcellators is used.

If you have not already gone through menopause, you'll no longer have periods, regardless of your age.

Many women have a hysterectomy. It's more common for women aged 40 to 50.

Uterine fibroids are benign smooth muscle tumors of the uterus and are one of the most common gynecological conditions affecting women of reproductive and perimenopausal age. When multiple fibroids cause severe symptoms such as heavy menstrual bleeding, pelvic pain, pressure symptoms, anemia, or infertility, hysterectomy becomes a definitive treatment. With advancements in minimally invasive surgery, laparoscopic hysterectomy using a 3-port technique has emerged as a safe, effective, and cosmetically superior option.

Indications for Laparoscopic Hysterectomy in Multiple Fibroids

Laparoscopic hysterectomy is recommended in patients with:

Multiple uterine fibroids

Heavy menstrual bleeding not responding to medical treatment

Severe dysmenorrhea or chronic pelvic pain

Pressure symptoms on bladder or bowel

Rapidly growing fibroids

Completed family or no desire for future fertility

Preoperative Evaluation

A thorough preoperative assessment is essential and includes:

Detailed medical history and clinical examination

Pelvic ultrasound or MRI to assess size, number, and location of fibroids

Hemoglobin and routine blood investigations

Endometrial sampling in selected cases

Counseling regarding procedure, risks, and benefits

Laparoscopic 3-Port Technique: Surgical Approach
Port Placement

The laparoscopic 3-port technique typically includes:

Primary Port (10 mm) – Umbilical port for laparoscope

Two Secondary Ports (5 mm each) – Placed in the right and left lower abdomen

This configuration allows optimal triangulation, precise dissection, and reduced surgical trauma.

Surgical Steps

Creation of pneumoperitoneum and diagnostic laparoscopy

Identification of uterus, fibroids, and surrounding pelvic structures

Coagulation and division of round ligaments

Skeletonization and sealing of uterine vessels

Careful dissection of bladder from the lower uterine segment

Colpotomy and removal of uterus vaginally or by contained morcellation

Vault closure laparoscopically

Advantages of Laparoscopic 3-Port Hysterectomy

Minimal blood loss

Reduced postoperative pain

Faster recovery and shorter hospital stay

Better cosmetic results

Lower risk of infection and adhesions

Early return to daily activities

Challenges in Multiple Fibroid Cases

Distorted pelvic anatomy

Limited uterine mobility

Increased operative time

Risk of bleeding

However, with experienced laparoscopic surgeons and advanced energy devices, these challenges can be effectively managed.

Postoperative Care and Recovery

Early ambulation within 6–8 hours

Oral intake on the same day or next day

Discharge usually within 24–48 hours

Return to normal activities within 1–2 weeks

Complications

Although rare, possible complications include:

Bleeding

Injury to bladder, bowel, or ureter

Infection

Vault-related complications

Proper patient selection and surgical expertise significantly reduce these risks.

Conclusion

Laparoscopic hysterectomy for multiple fibroids using a 3-port technique is a modern, minimally invasive, and patient-friendly approach. It offers excellent surgical outcomes with minimal morbidity, making it an ideal choice for women requiring definitive management of symptomatic multiple uterine fibroids. When performed by trained laparoscopic surgeons, it ensures safety, efficiency, and rapid recovery.