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| Name | TLH in Frozen Pelvis | Complex Dissection |
| Video Uploader | Video From Laparoscopy : Basics to Advanced. |
| Upload Date | This Video Uploaded At 27-07-2025 10:30:06 |
| Video Discription | This video demonstrates a challenging Total Laparoscopic Hysterectomy (TLH) in a patient with a frozen pelvis, where the uterus was not visible due to extensive adhesions. The pelvic anatomy was severely distorted, with the sigmoid colon, small intestine, and adnexa densely adherent to the bladder, completely obscuring the uterus. Key Surgical Steps Demonstrated: 1. Initial Access & Diagnosis: • Dense adhesions noted with no visualization of the uterus. • Sigmoid colon and small bowel adherent to the bladder, uterus, and adnexa. 2. Left-Sided Dissection: • Mobilization of the sigmoid colon was initiated. • The left ureter was clearly identified and safeguarded. • The infundibulopelvic ligament was divided after ureterolysis. 3. Right-Sided Dissection: • Similar dissection was carried out on the right side. • The right ovarian ligament and infundibulopelvic ligament were addressed. • The right ureter was dissected and preserved. 4. Bladder Mobilization: • The superior surface of the bladder and sigmoid colon was identified. • Dissection was meticulously performed using a combination of sharp and blunt techniques with the harmonic scalpel. • Minimal lateral spread of energy was ensured. 5. Uterine Artery Control: • Once the bladder was separated, the anterior surface of the uterus and left uterine artery were identified. • The artery was coagulated and divided safely. 6. Posterior Dissection: • The posterior surface of the uterus was obscured by adherent sigmoid colon. • The right uterosacral ligament was divided. • The rectum was carefully separated from the posterior vaginal wall. 7. Final Steps: • The right uterine artery was identified, coagulated, and divided. • The vagina was separated from the uterus. • Vault closure was performed laparoscopically. • Final hemostasis was confirmed. ⸻ 🔍 Key Highlights: • Advanced ureterolysis techniques • Bladder dissection in dense fibrosis • Energy control using harmonic scalpel • Management of obliterated pouch of Douglas • Safe vault closure in distorted anatomy Thanks for watching.Please do subscribe. Please visit my faceboook page https://www.facebook.com/ravikanth.gowder Please visit my instagram page www.instagram.com/drravikanthgo please visit twitter pagehttps://twitter.com/drravikanthgo |
| Category | Education |
| Tags | Ravikanth | Laparoscopy tips & tricks | drravikanthgo | Endoscopy | Total Laparoscopic Hysterectomy | TLH in Frozen Pelvis | Complex Laparoscopic Hysterectomy | Advanced Laparoscopic Gynecology | Frozen pelvic Dissection | Laparoscopic Ureterolysis | Bladder dissection Laparoscopy | Uterine artery ligation Laparoscopy | Sigmoid colonAdhesiolysis | Laparoscopic Vault closure | Indian laparoscopic surgeons | Harmonic scalpel inGynec Surgery | Lapariscopic Surgical Tips |
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