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This video demonstrates Total Laparoscopic Hysterectomy by three 5 mm ports by Dr. R K Mishra at World Laparoscopy Hospital. It is surgery we have also used stryker Ukit for added safety. Total laparoscopic hysterectomy is a safe and effective procedure for women needing a hysterectomy. We enjoy a high operative volume and perform approximately 150 total laparoscopic hysterectomy cases annually with a conversion rate of 1:500. The steps described herein 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.

Total Laparoscopic Hysterectomy (TLH) has become a gold-standard minimally invasive approach for the surgical removal of the uterus. With continuous advancements in laparoscopic instrumentation and surgical expertise, TLH can now be safely and effectively performed using only three 5 mm ports, offering excellent cosmetic and clinical outcomes. This approach represents a refinement of minimally invasive gynecologic surgery, focusing on reduced trauma without compromising surgical safety.

Rationale for Three 5 mm Port Technique

Traditional laparoscopic hysterectomy often uses one or more 10–12 mm ports. However, the three 5 mm port technique minimizes abdominal wall trauma, reduces postoperative pain, and improves patient satisfaction. Advances in energy devices, optics, and suturing techniques allow complex procedures to be completed efficiently through smaller ports.

Patient Selection

TLH using three 5 mm ports is suitable for patients with:

Benign uterine conditions (fibroids, adenomyosis, abnormal uterine bleeding)

Uterine size up to moderate enlargement

Endometriosis (mild to moderate)

Failed medical management

Careful preoperative evaluation, including imaging and clinical assessment, is essential to ensure safety and feasibility.

Port Placement

The procedure is performed using:

One 5 mm umbilical port for the laparoscope

Two 5 mm ancillary ports placed in the lower abdomen, typically in the right and left iliac fossae

This triangular configuration allows optimal ergonomics, instrument mobility, and precise dissection.

Surgical Technique

After establishing pneumoperitoneum, systematic pelvic inspection is performed. The steps include:

Coagulation and division of the round ligaments

Dissection of the bladder flap and identification of anatomical landmarks

Sealing and transection of the uterine vessels using advanced energy devices

Division of cardinal and uterosacral ligaments

Circumferential colpotomy

Vaginal removal of the uterus

Laparoscopic vault closure using intracorporeal suturing through 5 mm ports

Throughout the procedure, meticulous hemostasis and tissue handling are maintained.

Advantages of Three 5 mm Port TLH

Reduced postoperative pain

Minimal blood loss

Faster recovery and early ambulation

Shorter hospital stay

Superior cosmetic results

Lower risk of port-site complications

Postoperative Care and Recovery

Patients typically experience minimal discomfort and can resume normal activities earlier compared to open or conventional laparoscopic approaches. Early mobilization, pain control, and follow-up evaluation ensure optimal recovery.

Challenges and Learning Curve

Performing TLH through three 5 mm ports requires advanced laparoscopic skills, particularly in suturing and energy device usage. Proper training and adherence to standardized surgical steps are essential to overcome the learning curve.

Conclusion

Total Laparoscopic Hysterectomy by three 5 mm ports is a safe, effective, and patient-friendly surgical technique when performed by experienced laparoscopic surgeons. It exemplifies the evolution of minimally invasive gynecologic surgery toward reduced invasiveness with uncompromised surgical outcomes.

For more information please contact:
World Laparoscopy Hospital
Cyber City, Gurugram, NCR Delhi
INDIA 122002
Phone & WhatsApp: +919811416838, + 91 9999677788