A new technique and system for simplifying total laparoscopic hysterectomy

Because total laparoscopic hysterectomy (TLH) is technically challenging, laparoscopic-assisted vaginal hysterectomy is often the operation of choice, even in patients in whom it may not be successful. To encourage greater performance of TLH, I developed a technique and instrumentation that should enable gynecologists to do the operation successfully more often. The system consists of a pneumo-occluder and a cup, combined with a uterine manipulator. The cup, which is both visible and palpable, is placed over the cervix to delineate vaginal fornices, thus ensuring safe desiccation and avoiding ureteral dissection. Acceptable operating times allow TLH to be combined with other procedures, including excision of endometriosis, colposuspension, and enterocele repair.