Total Laparoscopic Hysterectomy (TLH) with Large Uterus by Comprehensive Canopy Concept, ‘The 3 Step Technique’

The chapter delves into nuances of tackling a large uterus laparoscopically which becomes challenging especially with previous surgeries and Caesarean section which obliterate the pouch of douglas. This chapter highlights the importance of meticulous preoperative evaluation including detailed history, scar evaluation, and advanced imaging techniques such as ultrasound and MRI to know exact location of myoma, and to differentiate it from adenomyosis and uterine sarcoma. Notably, the Jain point is introduced for strategic port placement, offering a safer entry into the abdominal cavity. The chapter details the surgical technique, emphasizing the posterior approach to uterine artery ligation and the Comprehensive Canopy Concept, ‘The 3 Step Technique’ adaptable to varying complexities. Vault closure techniques, uterine retrieval strategies, and postoperative care, including adherence to Enhanced Recovery After Surgery (ERAS) protocols, are thoroughly discussed. This chapter helps in understanding of TLH for large uteri, aiding surgeons in optimizing patient outcomes through meticulous planning and advanced surgical skills.