Total Laproscopic Hysterectomy (TLH) in Frozen Pelvis by the Comprehensive Canopy Technique, ‘3 Step Technique’

This 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. The 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.