Comprehensive Canopy Concept of Bladder Dissection ‘The 3 Step Technique’: An Approach to Total Laparoscopic Hysterectomy (TLH)

The comprehensive canopy concept for bladder dissection, ‘The 3 Step Technique’ is employed in patients undergoing Total Laparoscopic Hysterectomy (TLH) with extensive adhesions resulting from multiple caesarean sections and previous surgeries, particularly affecting the anterior cul-de-sac. To address the challenges beyond conventional lateral approach for bladder dissection, we have introduced the comprehensive canopy concept which unfolds in three distinct steps. The initial step involves a posterior approach to uterine artery dissection, coagulation and section. Subsequently, the second step entails the creation of a bladder canopy, strategically addressing varying levels of adherence. The third step, a recent addition, introduces an anterior approach to uterine artery dissection and coagulation. This includes reaching the contralateral uterine artery by the side of the manipulator cup rim in one single sweep. Termed the Comprehensive Canopy Concept, ‘The 3 Step Technique’, which benefits over the traditional lateral approach. It effectively manages the complexities of TLH in cases marked by heightened adhesions. The chapter provides a detailed exploration of each step, offering insights into their significance and implications.