TLH - 怎么做 - 腹腔镜下子宫全切术与子宫肌瘤

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一名47岁的女性报道月经过多的超声显示子宫肌瘤。由于她已经完成了她的家庭，因此计划为她进行全腹腔镜子宫切除术和双侧输卵管切除术。

通过使用谐波使左侧附件脱离，并且已经打开了子宫 - 瓣膜褶皱。

到右侧的下一轮韧带分离出子宫 - 膀胱褶皱，在发现膀胱后，子宫完成。和子宫骶骨脱离子宫，使标本小移动。 穹顶从左侧打开。

开放的整个过程直到右侧，因为从右侧变得更容易接近。

现在正确的附器分离和右卵巢韧带,右管,以及圆韧带切除使用谐波。任何小出血应该注意与双极的运动。现在正在做右侧子宫。

穹窿也从右侧打开。完成子宫切除的过程。子宫颈和子宫完全分离。

检查止血并将样品停留在上腹部一段时间。输卵管切除术右侧进展。 卵巢囊肿在右侧被验证，卵巢囊肿切除术完成。 他们的标本都停在阴道。

因为它的开口更容易，因为更小的标本可以在腹部找不到。这里左输卵管切除正在进行中使用谐波，这个左管也停在阴道。

整个子宫颈与齿状钳，并再次通过阴道提取它。如果标本是大的，我们将其阴道分离，否则可以从阴道中取出而没有粉碎它。

穹窿缝合用一mi-grill缝合在这里我们不使用quill缝合…第一个mi-grill缝线是足够充分在这个特殊的手术从一个到另一边。

缝合正在进行，这是非常好的做拱顶悬架。这是什么给你额外的优势，在全腹腔镜子宫切除术，你可以把输尿管吻合到穹窿，并给它一个很好的支持。因此，脱垂的机会较少。

取出针头，止血检查。

TLH - How to do - TLH with fibroid uterus by Dr Neena Singh in Ultra HD Video quality in Ultra HD Video quality. A Patient with uterus fibroids got done surgery. A 47 years old lady reported with menorrhagia on ultrasound shows fibroid uterus. As she had completed her family so total laparoscopic hysterectomy with bilateral salpingectomy was planned for her.

A 47 years old lady reported with menorrhagia on ultrasound shows fibroid uterus. As she had completed her family so total laparoscopic hysterectomy with bilateral salpingectomy was planned for her.

The left adnexa are being detached by using the harmonic and the utero-vesical fold has been opened up.

Go up to next round of ligament of the right side to separate out the utero-vesical fold, after having reflected the bladder the uterine were done. And the utero-sacral are detached from the uterus so that specimen little mobile. The vault is being opened from the left side.

The whole process of the vault opening is taken right up to the right side because it’s become easier to access from the right side.

Now the right adnexa are detached and the right ovarian ligament, right tube, as well as round ligament they are excised using harmonic. Any small bleeders should be taken care at that movement with the bipolar. Now uterine are being done on the right side.

The vault is opened from the right side as well. The process of hysterectomy is completed. The cervix and uterus is totally detached.

The hemostasis is checked and specimen is parked in the upper abdomen for a while. The salpingectomy on the right side on progress. Ovarian cyst on the right side is verified and ovarian cystectomy done. Both the specimen they were parked in the vagina.

As its opening is much easier because the smaller specimen can get lost in the abdomen. Here left salpingectomy is in progress using the harmonic and this left tube is also parked into the vagina.

Whole the cervix with the tooth forceps and extract it through the vagina again. If the specimen is big we morcellate it vaginally otherwise it can be retrieved it from the vaginal without mocellation.

The vault is stitched using number one mi-grill suture here we are not using quill suture... number one mi-grill suture is adequately sufficient in this particular surgery from one to the other side.

The suturing is being done and it is very good to do the vault suspension. That is what gives you the added advantage in total laparoscopic hysterectomy that you can stitch the ureterosacrals to the vault and give it a good support. So there is less chances to prolapse.

The needle is removed and hemostasis is checked. Thank You