Abstract
Total laparoscopic hysterectomy (TLH) may be difficult to complete in patients with adhesions due to endometriosis or anatomical distortions due to large myomas and cervical myomas. Our purpose is to consider methods for completing TLH in these difficult cases by referring to the basics of our standard procedure. In cases of cervical myoma, a myomectomy can correct anatomical distortion and facilitate safer and easier TLH. In cases of endometriosis, ureteral injury can occur due to adhesions and anatomical distortion. To address this, we initially identify and isolate the ureter and expose the ureteral tunnel to track its course. These steps help us overcome difficulties during the procedure, enabling a safe TLH. In addition, in our experience, a retrograde approach to the vagina is useful in cases with cul-de-sac adhesions. With these techniques, it is possible to complete TLH safely even in difficult cases. We were able to complete simple hysterectomy totally laparoscopically in 99% of cases.
