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This video demonstrates Total Laparoscopic Hysterectomy by Two Ports. Only Two 5mm ports were used in this surgery. One telescopic port and only one working instrument are used. This is the first single-handed Total laparoscopic hysterectomy done by anyone before. Many surgeons are performing SILS hysterectomy. In single incision laparoscopic surgery one large 20mm-30mm port is used and in a single port three instruments are introduced. In this two-part surgery, only one operating instrument is used. Single-incision laparoscopic surgery is an alternative to conventional multiport laparoscopy. Single-access laparoscopy using a transumbilical 20 mm port does not give cosmetic benefits because the surgical incision is large in the umbilicus and increases hernia infection and morbidity of minimally invasive surgery. With two 5 mm ports, there is no chance of hernia excellent cosmetic benefits and minimum pain is observed. The patient is discharged only a few hours after surgery. This is a single-handed surgery so surgeons need good suturing skills.

Total Laparoscopic Hysterectomy by Two 5 mm Ports – Single Instrument Surgery

Total Laparoscopic Hysterectomy (TLH) is a minimally invasive surgical procedure that has revolutionized gynecological surgery. Traditionally, TLH involves multiple ports and various instruments to achieve uterine removal with minimal patient trauma. However, advancements in laparoscopic techniques have led to the development of a novel approach: TLH using only two 5 mm ports with a single instrument, optimizing efficiency while reducing surgical invasiveness.

The Evolution of Laparoscopic Hysterectomy
Conventional TLH techniques typically require three to four trocar placements, including a larger 10 mm port for the camera and multiple accessory ports for surgical instruments. The need for multiple access points increases the risk of postoperative pain, scarring, and complications. In contrast, the two-port, single-instrument TLH method significantly reduces these concerns while maintaining surgical precision.

Surgical Technique
Patient Preparation
- Preoperative evaluation includes thorough imaging and blood work to assess uterine size and any potential complications.
- The patient is positioned in the lithotomy position with steep Trendelenburg to optimize abdominal exposure.

Port Placement
- First 5 mm Port: Placed at the umbilicus for the high-definition laparoscopic camera.
- Second 5 mm Port: Placed in the lower abdomen, usually in the suprapubic region, serving as the working port.

Single-Instrument Approach
- A versatile, multifunctional laparoscopic instrument, such as a bipolar energy device or an articulating instrument, is used for dissection, coagulation, and tissue removal.
- The uterus is carefully mobilized, with strategic coagulation of the uterine arteries.
- The colpotomy is performed laparoscopically, and the uterus is removed vaginally.

Closure and Recovery
- The vaginal vault is sutured laparoscopically using barbed sutures, ensuring secure closure.
- Ports are removed, and minimal suturing is needed for the small incisions.
- Patients typically experience reduced postoperative pain and faster recovery compared to conventional TLH.

Advantages of the Two 5 mm Port TLH Technique
✅ Minimized Invasiveness – Smaller incisions lead to less tissue trauma and better cosmetic outcomes.
✅ Reduced Postoperative Pain – Fewer ports result in reduced pain and faster recovery.
✅ Shorter Hospital Stay – Many patients can be discharged within 24 hours.
✅ Lower Risk of Complications – Reduced trocar sites decrease the chances of herniation and infection.
✅ Cost-Effectiveness – Fewer instruments and ports mean lower procedural costs.

Challenges and Considerations
- Learning Curve: Surgeons must develop expertise in maneuvering a single instrument efficiently.
- Patient Selection: Best suited for cases without severe adhesions or large fibroids.
- Instrument Limitations: Requires highly adaptable, multifunctional instruments to compensate for the limited access.

Conclusion
The evolution of laparoscopic surgery continues to push the boundaries of minimally invasive techniques. Total Laparoscopic Hysterectomy using two 5 mm ports and a single instrument is a groundbreaking approach that maximizes surgical efficiency while minimizing patient trauma. With proper training and patient selection, this technique can redefine the standards of gynecological surgery, offering better outcomes and faster recovery times.


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