Total Laparoscopic Hysterectomy (TLH) is a minimally invasive surgical procedure for removing the uterus. When combined with cystoscopy and infrared ureteric catheterization, the surgery aims to ensure comprehensive management of pelvic organs while minimizing complications. Here is an in-depth look at this procedure:

Total Laparoscopic Hysterectomy (TLH)

Overview
TLH is performed to treat various gynecological conditions such as fibroids, endometriosis, uterine prolapse, and certain cancers. It is preferred over traditional open surgery due to its minimally invasive nature, leading to quicker recovery times, less postoperative pain, and reduced risk of infection.

Procedure
1. Preoperative Preparation: Patients undergo thorough evaluation, including imaging studies and lab tests. Bowel preparation and prophylactic antibiotics may be administered.
2. Anesthesia: The procedure is performed under general anesthesia.
3. Patient Positioning: The patient is placed in a dorsal lithotomy position with Trendelenburg tilt to provide better access to pelvic organs.
4. Port Placement: Several small incisions are made in the abdomen to insert trocars. Typically, a camera port is placed at the umbilicus, and additional ports are placed in the lower abdomen.
5. Laparoscopy: A laparoscope (a thin tube with a camera) is inserted to visualize the pelvic organs. Carbon dioxide gas is used to inflate the abdomen for better visibility and space to operate.
6. Dissection and Uterine Removal: The uterus is dissected from its surrounding structures. This involves:
- Cutting and sealing of blood vessels: Using energy devices like bipolar cautery or harmonic scalpel.
- Dissection of the bladder: The bladder is separated from the uterus to avoid injury.
- Ureter Identification: The ureters are identified and protected during the procedure.
- Uterine Manipulation: A uterine manipulator may be used to facilitate dissection.
7. Morcellation or Extraction: The uterus is removed either by morcellation (cutting it into smaller pieces) or through the vagina if feasible.

Cystoscopy

Purpose
Cystoscopy is performed to visualize the bladder and urethra directly. It is particularly useful in TLH to:
- Ensure the integrity of the bladder and ureters.
- Identify any injury to the urinary tract during surgery.
- Confirm proper placement of ureteric catheters.

Procedure
1. Insertion of Cystoscope: After the TLH, a cystoscope (a thin tube with a camera) is inserted through the urethra into the bladder.
2. Bladder Examination: The bladder is examined for any injuries, bleeding, or abnormalities.
3. Ureteral Orifice Examination: The openings of the ureters into the bladder are inspected to ensure no damage has occurred.

Infrared Ureteric Catheterization

Purpose
Infrared ureteric catheterization enhances the safety of TLH by:
- Providing real-time visualization of the ureters.
- Reducing the risk of ureteral injury.
- Assisting in the identification and protection of ureters during dissection.

Procedure
1. Insertion of Catheters: Ureteric catheters equipped with infrared capability are inserted through the urethra and guided into the ureters.
2. Infrared Imaging: During TLH, an infrared camera is used to visualize the catheters, highlighting the ureters' location.
3. Continuous Monitoring: The surgeon continuously monitors the ureters' position to avoid accidental injury during the dissection.

Postoperative Care

Immediate Postoperative Care
- Monitoring: Patients are monitored in the recovery room for vital signs, pain, and any immediate complications.
- Pain Management: Pain relief is managed with medications.
- Bladder Function: Bladder function is assessed, especially if cystoscopy and ureteric catheterization were performed.

Recovery
- Hospital Stay: Most patients stay in the hospital for 1-2 days postoperatively.
- Activity Restrictions: Patients are advised to avoid heavy lifting and strenuous activities for several weeks.
- Follow-Up: Regular follow-up visits are scheduled to monitor recovery and address any concerns.

Complications
- General Complications: Include infection, bleeding, and reactions to anesthesia.
- Specific Complications: Include injury to the bladder, ureters, or surrounding organs, which is minimized with the use of cystoscopy and infrared ureteric catheterization.

Benefits of Combined Approach

Enhanced Safety
Combining TLH with cystoscopy and infrared ureteric catheterization significantly enhances the safety of the procedure. The real-time visualization of the ureters and bladder allows for immediate identification and correction of any inadvertent injuries.

Improved Outcomes
Patients benefit from reduced risk of urinary tract injuries, fewer complications, and quicker recovery times. The minimally invasive nature of TLH combined with the protective measures ensures optimal outcomes.

Reduced Postoperative Morbidity
The precise identification and protection of the ureters during surgery reduce postoperative morbidity associated with urinary tract injuries. This results in fewer reoperations, less postoperative pain, and shorter hospital stays.

Conclusion
Total Laparoscopic Hysterectomy with cystoscopy and infrared ureteric catheterization represents a significant advancement in gynecological surgery. This combined approach offers enhanced safety, improved outcomes, and reduced postoperative morbidity. As technology advances, these techniques will continue to evolve, providing even better care for patients undergoing hysterectomy procedures.