This educational video demonstrates Total Laparoscopic Hysterectomy (TLH) performed using the three-port technique with the assistance of an infrared ureteric catheter. The video highlights precise surgical steps, safe identification of the ureters, and advanced laparoscopic techniques to enhance patient safety and surgical outcomes. Ideal for gynecologists, laparoscopic surgeons, and medical trainees, this video provides valuable insights into modern minimally invasive gynecologic surgery.

Total Laparoscopic Hysterectomy (TLH) by Three Port and Infrared Ureteric Catheter is the most common major gynecological procedure in women and minimally invasive approaches should be used wherever possible; total laparoscopic hysterectomy (TLH) is one such surgical approach which allows removal of the uterus entirely laparoscopically. However, the lack of surgical training opportunities is impeding its increased adoption. This video will formally test a surgical outreach training model to equip surgeons with the skills to provide TLH as an alternative to total abdominal hysterectomy (TAH). 

Total Laparoscopic Hysterectomy (TLH) has revolutionized gynecological surgery by offering a minimally invasive alternative to open hysterectomy. With continuous advancements in laparoscopic technology, techniques such as the three-port approach combined with the use of an infrared ureteric catheter have significantly enhanced surgical precision and patient safety. This modern approach reduces operative trauma while ensuring optimal visualization of critical anatomical structures.

Rationale for the Three-Port Technique

The three-port TLH technique is designed to minimize abdominal wall trauma without compromising surgical efficiency. Compared to conventional multi-port laparoscopy, the three-port method offers:

Reduced postoperative pain

Improved cosmetic outcomes

Faster recovery and early mobilization

Decreased risk of port-related complications

This technique requires advanced laparoscopic expertise and careful port placement to ensure ergonomic handling of instruments and optimal visualization.

Role of Infrared Ureteric Catheter

Ureteric injury is a known risk during hysterectomy, especially in cases of dense adhesions, endometriosis, or large uteri. The infrared ureteric catheter provides real-time visualization of the ureters using near-infrared imaging technology. Its advantages include:

Enhanced identification of ureteric course

Reduced risk of inadvertent ureteric injury

Increased surgeon confidence in difficult pelvic anatomy

Improved safety in complex or redo surgeries

The catheter emits infrared signals, allowing surgeons to clearly identify ureters even when distorted by pathology.

Surgical Technique Overview

After establishing pneumoperitoneum, three laparoscopic ports are strategically placed. The infrared ureteric catheter is inserted cystoscopically prior to the laparoscopic procedure. Under laparoscopic visualization, the surgeon proceeds with:

Identification and safeguarding of ureters using infrared imaging

Coagulation and division of uterine vessels

Dissection of cardinal and uterosacral ligaments

Circumferential colpotomy

Vaginal retrieval of the uterus

Laparoscopic vault closure

Throughout the procedure, continuous awareness of ureteric location enhances operative safety.

Clinical Advantages

The combination of a three-port TLH with infrared ureteric catheterization offers multiple benefits:

Lower incidence of ureteric injuries

Reduced operative time in complex cases

Minimal blood loss

Short hospital stay

Early return to normal activities

These benefits make the technique particularly useful in high-risk hysterectomies.

Indications

This approach is especially beneficial in:

Large uterine fibroids

Severe endometriosis

Pelvic adhesions

Previous pelvic surgeries

Obese patients

Postoperative Outcomes

Patients typically experience minimal postoperative pain, early ambulation, and rapid recovery. Most patients can be discharged within 24–48 hours with excellent surgical and cosmetic outcomes.

Conclusion

Total Laparoscopic Hysterectomy by the three-port technique with infrared ureteric catheter represents a significant advancement in minimally invasive gynecologic surgery. By combining reduced port access with enhanced ureteric visualization, this approach improves surgical safety, efficiency, and patient outcomes. As laparoscopic expertise and imaging technologies continue to evolve, such innovations will set new standards for hysterectomy procedures worldwide.