This video is about transforming gynecological procedures with 3-Port Total Laparoscopic Hysterectomy and Sacrocolpopexy.In the realm of gynecological surgeries, advancements in surgical techniques have brought about a remarkable transformation in the way complex procedures are performed. One such innovation that has revolutionized the field is the 3-Port Total Laparoscopic Hysterectomy with Sacrocolpopexy. This groundbreaking approach combines the benefits of minimally invasive surgery with the effectiveness of addressing multiple gynecological conditions. Let us delve into the details of this surgical innovation and its impact on gynecological procedures.

The 3-Port Total Laparoscopic Hysterectomy with Sacrocolpopexy is a technique that enables the removal of the uterus and the correction of pelvic organ prolapse through a minimally invasive approach. Traditionally, hysterectomies and sacrocolpopexies were performed using open surgery, involving large incisions and longer recovery periods. However, with the advent of laparoscopic techniques, surgeons have been able to perform these procedures with greater precision and minimal invasiveness.

This innovative surgical approach involves making three small incisions in the abdomen, through which specialized laparoscopic instruments and a camera are inserted. The surgeon gains access to the pelvic region and carefully performs the necessary steps to remove the uterus and correct pelvic organ prolapse. The laparoscopic camera provides a magnified and clear view of the surgical field, allowing the surgeon to navigate with enhanced precision.

The advantages of the 3-Port Total Laparoscopic Hysterectomy with Sacrocolpopexy are manifold. Firstly, the minimally invasive nature of the procedure results in reduced post-operative pain and discomfort for patients. The smaller incisions lead to less tissue trauma and quicker healing, enabling a faster recovery and shorter hospital stay. Patients can regain their normal activities and quality of life more rapidly compared to traditional open surgery.

Moreover, the laparoscopic approach offers improved cosmetic outcomes as the smaller incisions result in minimal scarring. This aesthetic benefit is particularly important for many patients, enhancing their overall satisfaction with the procedure.

Another significant advantage of this surgical innovation is its efficacy in addressing multiple gynecological conditions simultaneously. The 3-Port Total Laparoscopic Hysterectomy not only allows for the removal of the uterus but also facilitates the correction of pelvic organ prolapse through Sacrocolpopexy. This procedure involves suspending the vagina and supporting structures to restore their normal position and function. By addressing both conditions in a single surgery, patients can experience comprehensive relief and improved overall health outcomes.

The transformative impact of the 3-Port Total Laparoscopic Hysterectomy with Sacrocolpopexy extends beyond patient benefits. The minimally invasive approach reduces the risk of surgical complications, such as infection and excessive bleeding. It also contributes to shorter operating times, optimizing surgical efficiency and utilization of healthcare resources.

Furthermore, the adoption of this innovative technique signifies the continuous evolution of gynecological surgical practices. Surgeons who embrace and master this approach demonstrate their commitment to staying at the forefront of surgical advancements and delivering the highest quality of care to their patients. This surgical innovation serves as a testament to the ongoing pursuit of excellence in gynecological procedures.

Performing a Total Laparoscopic Hysterectomy (TLH) with Sacrocolpopexy using the Three-Port technique requires precision, expertise, and adherence to a systematic approach. Here is a step-by-step guide on how to perform this surgical procedure:

1. Preoperative Preparation: Before the surgery, ensure proper patient evaluation, informed consent, and preoperative optimization. Assess the patient's medical history, perform necessary investigations, and provide appropriate counseling.

2. Anesthesia and Patient Positioning: Administer general anesthesia and place the patient in the lithotomy position, ensuring proper padding and support to prevent any pressure-related injuries. Position the patient's arms comfortably alongside the body.

3. Port Placement: Make three small incisions in the abdomen, following the principles of triangulation. The first port, usually a 10 or 12 mm umbilical trocar, is inserted to accommodate the laparoscope for visualization. The second port, typically a 5 or 10 mm trocar, is placed in the suprapubic region. The third port, another 5 or 10 mm trocar, is positioned in the right or left iliac fossa.

4. Creation of Pneumoperitoneum: Introduce carbon dioxide gas into the abdominal cavity through the umbilical port to create a pneumoperitoneum, ensuring adequate intra-abdominal pressure for visualization and surgical manipulation.

5. Exploration and Adhesiolysis: Begin with a thorough exploration of the pelvis and abdomen, assessing any adhesions or abnormal findings. Perform adhesiolysis as necessary to create a clear surgical field and ensure proper visualization of pelvic organs.

6. Uterine Mobilization and Vascular Control: Start the uterine mobilization by ligating the round ligaments close to the uterus. Proceed with the dissection of the bladder peritoneum to expose the anterior aspect of the cervix. Identify and secure the uterine arteries bilaterally, using bipolar energy devices or sutures, and proceed with their ligation and division.

7. Uterosacral Ligament Transection: Identify the uterosacral ligaments bilaterally and dissect them from the rectum. Transect the uterosacral ligaments using scissors or an energy device, ensuring complete division.

8. Vaginal Incision and Hysterectomy: Perform a small vaginal incision to facilitate the extraction of the uterus. Extend the incision as needed for adequate exposure. Proceed with the division of the cardinal ligaments and other supportive structures. Carefully remove the uterus through the vaginal incision.

9. Vault Suspension and Sacrocolpopexy: Begin the vault suspension by exposing the sacral promontory. Prepare the sacral periosteum and attach a mesh graft to it using non-absorbable sutures. Securely fix the mesh graft to the vaginal cuff and the sacral promontory, providing durable support and correction of pelvic organ prolapse.

10. Hemostasis and Closure: Ensure meticulous hemostasis throughout the procedure, using bipolar energy devices, sutures, or hemostatic agents as needed. Irrigate the surgical field to remove any debris or blood clots. Close the vaginal incision with absorbable sutures and close the skin incisions with skin adhesive or sutures.

11. Postoperative Care: Extubate the patient carefully and transfer them to the recovery area for monitoring. Provide appropriate postoperative pain management, prophylactic antibiotics, and venous thromboembolism prophylaxis. Monitor the patient closely for any signs of complications and provide necessary instructions for follow-up care.

It is crucial to note that this step-by-step guide provides a general overview of the surgical procedure. The actual surgical approach may vary depending on the surgeon's preferences, patient characteristics, and specific anatomical considerations. Surgeons should follow established guidelines, adhere to best practices, and consider individual patient factors to ensure optimal outcomes and patient safety.

Total Laparoscopic Hysterectomy (TLH) with Sacrocolpopexy performed using the Three-Port technique offers several advantages over traditional open surgery or alternative laparoscopic approaches. These advantages include:

1. Minimally Invasive: The Three-Port technique utilizes small incisions in the abdomen, resulting in less tissue trauma and reduced postoperative pain compared to open surgery. It offers the benefits of a minimally invasive approach, including faster recovery, shorter hospital stays, and quicker return to daily activities.

2. Enhanced Cosmesis: With the Three-Port technique, the incisions made are smaller compared to open surgery, resulting in minimal scarring and improved cosmetic outcomes. This is particularly important for many patients, as it helps maintain body image and boosts overall satisfaction with the procedure.

3. Precise Visualization: The laparoscopic camera used in TLH with Sacrocolpopexy provides magnified, high-definition visualization of the surgical field. This enhances the surgeon's ability to identify anatomical structures, accurately dissect tissues, and perform precise suturing. Clear visualization contributes to the safety and efficacy of the procedure.

4. Reduced Blood Loss: The meticulous dissection and cauterization techniques utilized in the Three-Port technique minimize blood loss during the surgery. The use of specialized laparoscopic instruments, including energy devices, allows for precise control of bleeding vessels, reducing the need for blood transfusions.

5. Shorter Hospital Stay: Patients undergoing TLH with Sacrocolpopexy using the Three-Port technique typically experience a shorter hospital stay compared to open surgery. The minimally invasive nature of the procedure and the faster recovery associated with it contribute to an early discharge, enabling patients to return to the comfort of their homes sooner.

6. Lower Risk of Complications: The Three-Port technique reduces the risk of surgical complications such as wound infections, incisional hernias, and postoperative adhesions. By minimizing tissue trauma and employing meticulous surgical techniques, the procedure promotes faster healing and lowers the chances of adverse events.

7. Comprehensive Treatment: TLH with Sacrocolpopexy addresses multiple gynecological conditions in a single surgery. In addition to hysterectomy, it allows for the correction of pelvic organ prolapse through sacrocolpopexy. This comprehensive approach saves patients from the need for separate surgeries and provides a more efficient and effective treatment option.

8. Patient Satisfaction: The advantages of the Three-Port technique, including reduced pain, smaller incisions, and faster recovery, contribute to higher patient satisfaction rates. Patients appreciate the improved cosmetic outcomes, shorter hospital stays, and quicker return to their normal activities and quality of life.

While the Three-Port technique offers numerous advantages, it is essential to consider individual patient factors and ensure proper patient selection. The surgeon's expertise, experience, and adherence to best practices are crucial for achieving optimal outcomes and patient safety.

TLH with Sacrocolpopexy performed using the Three-Port technique represents a significant advancement in gynecological surgery. The minimally invasive approach, enhanced visualization, reduced blood loss, and comprehensive treatment options make it a preferred choice for patients and surgeons alike. By harnessing these advantages, this technique continues to transform the field of gynecological surgery, offering improved outcomes and enhanced patient experiences.

While Total Laparoscopic Hysterectomy (TLH) with Sacrocolpopexy using the Three-Port technique is generally considered safe, like any surgical procedure, it carries certain potential complications. It is important for both patients and surgeons to be aware of these risks and take necessary precautions. Some possible complications of TLH with Sacrocolpopexy include:

1. Bleeding: There is a risk of bleeding during the surgery, which can range from minor to severe. The surgeon must exercise caution to control bleeding vessels and ensure proper hemostasis. In rare cases, significant blood loss may necessitate blood transfusions or additional interventions to address the bleeding.

2. Infection: As with any surgical procedure, there is a risk of infection at the incision sites or within the pelvic cavity. Surgeons take precautions such as using sterile techniques, administering prophylactic antibiotics, and ensuring proper wound care to minimize the risk of infection. However, in some cases, infections may still occur, requiring additional treatment with antibiotics or drainage of abscesses.

3. Injury to Nearby Structures: During TLH with Sacrocolpopexy, there is a potential risk of injury to adjacent structures such as the bladder, ureters, intestines, or blood vessels. Surgeons must exercise extreme care to identify and protect these structures during dissection and suturing. In rare instances, inadvertent injury may occur, requiring immediate repair or further intervention.

4. Urinary Complications: There is a risk of urinary complications following the procedure, including urinary retention, urinary tract infection, or injury to the bladder or ureters. These complications may lead to symptoms such as difficulty urinating, frequent urination, or pain during urination. Prompt recognition and management of such complications are essential to prevent further complications or long-term urinary issues.

5. Vaginal Vault Dehiscence: In some cases, there may be a separation or breakdown of the vaginal cuff closure, leading to vaginal vault dehiscence. This can result in vaginal prolapse, bleeding, infection, or discomfort. Proper surgical technique, appropriate suture materials, and adequate postoperative care are crucial in minimizing the risk of vault dehiscence.

6. Mesh-related Complications: Sacrocolpopexy involves the use of mesh grafts to support the vaginal cuff. While mesh-related complications are relatively rare, they can include mesh erosion, infection, pain, or discomfort. Surgeons should carefully select appropriate mesh materials, follow recommended techniques for implantation, and provide comprehensive patient education regarding potential mesh-related risks.

7. Anesthesia-related Risks: General anesthesia carries its own set of risks, including allergic reactions, adverse drug reactions, respiratory complications, or cardiovascular events. Anesthesiologists work closely with the surgical team to ensure patient safety and minimize these risks.

8. General Surgical Risks: In addition to procedure-specific complications, TLH with Sacrocolpopexy shares general surgical risks such as blood clots, wound complications, scar formation, or postoperative pain. Steps are taken to prevent and manage these risks, including appropriate prophylaxis, careful wound closure, and effective pain management strategies.

It is important to note that while these complications are possible, the actual occurrence rates vary and depend on various factors such as patient characteristics, surgical expertise, and adherence to best practices. Surgeons thoroughly evaluate patients, provide appropriate counseling, and take necessary precautions to minimize the risks associated with TLH with Sacrocolpopexy. Patients should communicate any concerns or symptoms to their healthcare providers promptly to ensure timely management and optimal outcomes.

Conclusion:
The 3-Port Total Laparoscopic Hysterectomy with Sacrocolpopexy represents a remarkable leap forward in gynecological surgery. Its ability to combine the benefits of minimally invasive surgery, reduced post-operative pain, improved cosmetic outcomes, and simultaneous treatment of multiple conditions has transformed the way gynecological procedures are performed. By unleashing surgical innovation, this technique has elevated the standard of care and improved the lives of countless patients worldwide.