{"paper_id":"5fd7ae37-49dd-44c1-aff9-775b0cab24d5","body_text":"Abstract\nThis chapter explains intricacies of Total Laparoscopic Hysterectomy (TLH) in the context of challenging situations of frozen pelvis, characterized by extensive adhesive diseases, involving bowel, omentum and various organs in the abdomen & pelvis. Frozen pelvis often results from conditions such as endometriosis, cancers, and infectious pathologies like Pelvic Inflammatory Disease (PID), Koch’s and previous surgeries for septicaemia and tubo-ovarian abscess. Such extensive adhesions involving vital organs present unique challenges in surgery, requiring utmost patience and skills, along with help from modern gadgets.\nThe clinical presentation of frozen pelvis cases involve menstrual disorders, lower abdominal pain, and tubo-ovarian masses. Pelvic examination, ultrasound, and specific lab tests help in guiding the comprehensive preoperative evaluation, to meet the challenges posed by bowel adhesions. The surgical approach emphasizes bowel adhesiolysis, precise ureteral identification with Indocyanine Green (ICG), and a systematic Comprehensive Canopy Concept, ‘The 3 Step Technique’ for addressing bladder dissection in TLH (total laparoscopic hysterectomy). The chapter underscores the importance of on-table decision-making, provisional consent for ovarian removal and provides valuable clinical insights for practitioners dealing with patients having frozen pelvis, posted for TLH.\nAccess this chapter\nTax calculation will be finalised at checkout\nPurchases are for personal use only\nSimilar content being viewed by others\nReferences\nDonald PG, Michael JC. Surgical strategies to untangle a frozen pelvis. OBG Manag. 2007;19(3):62\nKataoka ML, Togashi K, Yamaoka T, Koyama T, Ueda H, Kobayashi H, Rahman M, Higuchi T, Fujii S. Posterior cul-de-sac obliteration associated with endometriosis: MR imaging evaluation. Radiology. 2005;234(3):815–23.\nHudson CN. Victor Bonney lecture, 1980. Ovarian cancer—a gynaecological disorder? Ann R Coll Surg Engl. 1981;63:118–25.\nVolpi E, Bernardini L, Ferrero AM. The retrograde and retroperitoneal totally laparoscopic hysterectomy for endometrial cancer. Int J Surg Oncol. 2012;2012:263850.\nJennings LK, Krywko DM. Pelvic inflammatory disease. StatPearls. 2023 Mar 13.\nSharma JB, Sharma SK, Dharmendra S, Singh UB, Kumar S, Roy KK. Laparoscopic evaluation of female genital tuberculosis in infertility: an observational study. Indian J Med Res. 2023;157(2&3):183–91. https://doi.org/10.4103/ijmr.ijmr_2498_21. PMID: 37202937; PMCID: PMC10319378.\nStovall TG. Hysterectomy. In: Berek JS, editor. Berek & Novak’s gynecology. 14th ed. Philadelphia: Lippincott Williams & Wilkins; 2007. p. 805–46.\nPaul PG, Shabnam K, Bhosale SA, Kaur H, Talwar P, Thomas T. Laparoscopic hysterectomy in frozen pelvis—an alternative technique of retrograde adhesiolysis. Gynecol Surg. 2013;10(4):285–90. https://doi.org/10.1007/s10397-013-0810-8.\nWalid SM, Heaton RL. Total laparoscopic extirpation of a fixed uterus from benign gynecological disease. Gynecol Surg. 2011;8:157–9.\nRadswiki T, Campos A, Knipe H, et al. Pelvic inflammatory disease. Reference article, Radiopaedia.org. https://radiopaedia.org/articles/14987. Accessed 26 Jan 2024.\nJain N, Sareen S, Kanawa S, Jain V, Gupta S, Mann S. Jain point: a new safe portal for laparoscopic entry in previous surgery cases. J Hum Reprod Sci. 2016;9(1):9–17. https://doi.org/10.4103/0974-1208.178637. PMID: 27110072; PMCID: PMC4817291.\nAuthor information\nAuthors and Affiliations\nEditor information\nEditors and Affiliations\nEthics declarations\nThe author declares no conflict of interest that are relevant to content of this chapter.\nEthical Approval\nInformed consent was obtained from individual participants and patients regarding publication and documentation without disclosing their identity.\nRights and permissions\nCopyright information\n© 2024 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.\nAbout this chapter\nCite this chapter\nJain, N., Jain, V., Srivastava, S. (2024). Total Laproscopic Hysterectomy (TLH) in Frozen Pelvis by the Comprehensive Canopy Technique, ‘3 Step Technique’. In: Jain, N. (eds) Complex Total Laparoscopic Hysterectomy (TLH) with Newer Approaches in Bladder Dissection. Springer, Singapore. https://doi.org/10.1007/978-981-97-3226-5_12\nDownload citation\nDOI: https://doi.org/10.1007/978-981-97-3226-5_12\nPublished:\nPublisher Name: Springer, Singapore\nPrint ISBN: 978-981-97-3225-8\nOnline ISBN: 978-981-97-3226-5\neBook Packages: MedicineMedicine (R0)","source_license":"CC0","license_restricted":false}