From the Research
The outlined procedural steps for a Total Laparoscopic Hysterectomy (TLH) with salpingectomy are generally correct, but may require modifications based on individual patient anatomy and clinical circumstances. A standard TLH with salpingectomy typically involves patient positioning in dorsal lithotomy, establishment of pneumoperitoneum, placement of multiple ports (usually umbilical, right and left lower quadrant), uterine manipulation with a vaginal manipulator, identification of key anatomical structures, securing and dividing the round ligaments, opening the broad ligament, identifying and preserving the ureter, securing and dividing the infundibulopelvic ligaments (for salpingectomy), skeletonizing and securing the uterine vessels, developing the vesicouterine space, colpotomy around the cervix, removal of the uterus and fallopian tubes through the vagina, and closure of the vaginal cuff with laparoscopic suturing 1.
The procedure requires careful attention to hemostasis throughout and meticulous dissection to avoid injury to surrounding structures, particularly the ureters, bladder, and bowel. Variations in technique exist depending on surgeon preference, patient anatomy, and specific clinical circumstances. For example, some studies suggest that prophylactic salpingectomy can be performed during elective laparoscopic cholecystectomy, with a low complication rate and no significant increase in operating time 2.
Key steps in the procedure include:
- Securing and dividing the round ligaments
- Opening the broad ligament and identifying the ureter
- Securing and dividing the infundibulopelvic ligaments (for salpingectomy)
- Developing the vesicouterine space
- Colpotomy around the cervix
- Removal of the uterus and fallopian tubes through the vagina
- Closure of the vaginal cuff with laparoscopic suturing
It is essential to note that the procedure should be tailored to the individual patient's needs and anatomy, and that careful attention to detail and meticulous dissection are crucial to minimizing the risk of complications 3. Additionally, the decision to perform a salpingectomy should be made on a case-by-case basis, taking into account the patient's medical history, age, and other factors 4.
In terms of specific procedural steps, the outlined steps are generally consistent with those described in the literature, including the use of electrocautery to transect the fallopian tube and utero-ovarian ligament, and the importance of maintaining the IP ligament to supply blood to the ovary from the pelvic side-wall if the ovaries are being preserved 5. However, the specific details of the procedure may vary depending on the individual patient and the surgeon's preference.