A Total Laparoscopic Hysterectomy (TLH) involves removal of ovaries, fallopian tubes and uterus and closing the vaginal cuff laparoscopically. The uterus can be removed vaginally or abdominally. Now even single incision and robotic assisted TLH is possible.
1. Better visualisation especially in patients with a narrow pelvis
2. Lesser bleeding.
3. Lower wound infection rate
4. Lesser postoperative pain
5. Shorter hospital stay
6. Faster return to normal activity.
2. Pelvic organ prolapse
3. Abnormal bleeding
4. Uterine and ovarian tumours
Multiple previous surgeries leading to adhesions
Large lower segment fibroids
Multiple caesaerian sections
Trocar injuries: to blood vessels or bowel. Can be avoided by open technique of trocar insertion
Bleeding : injury to iliac vessels, from uterine pedicle
Bowel injuries: Adhesions from pelvic inflammatory disease, diverticulitis in absence of previous surgeries may also lead to bowel injuries
Abdominal wall hematomas
Incisional hernia at the port sites