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Sun beams on hysterectomies

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Figure

Fig. 1 Variations of laparoscopic hysterectomies (bluefurther surgery.the round ligament, adnexa and infundibulopelvic ligament from thepelvic side wall above the cardinal ligament with or withoutlymphadenectomy; the uterus is extracted via the vagina
Fig. 2 Total laparoscopic hys-terectomy (TLH). a Multifibroiduterus, b dissection of the leftround ligament, c preparation ofleft uterine vessels, d presenta-tion of right uterine vessels, eultrasound coagulation and sep-aration of right uterine vessels, fischemic uterus elevated by theuterine manipulator according toMangeshikar, g vaginal delinea-tion line on the ceramic cap ofthe Mangeshikar manipulator,h separation of cervix fromvagina using the monopolarhook, i the cap becomes visiblein the vaginal fornix, j continu-ous dissection of uterus fromvagina, k extraction of a 210-guterus from vagina and l reinser-tion of the manipulator tubewith ceramic cap to keep thepneumoperitoneum, closure ofvaginal stump with a continuoussuture and two corner sutures.To prevent enterocele formation,the sacrouterine ligaments areattached to the vaginal stump
Fig. 2 (continued)
Fig. 3 Classic intrafascial sub-total hysterectomy (CISH).Multifibroid uterus,of left adnexa from the uteruswith a stapler,vesico-uterine space,tion of the bladder,stration of the pericervicalfascial ring, a b dissection c opening of the d prepara- e demon- f transcervical andtransuterine resection of a 15-mm tissue cylinder including the“transformation zone around anaxial guide rod”, g positioningof a “Roeder loop” as tourniquetto tie the ascending branches ofthe uterine arteries, h sharp dis-section of cervix from the uter-ine corpus with scissors (or amonopolar loop as LINA Loopor Storz cervical loop), i furthercervical dissection, j separationof uterine body from the cervix,k morcellation of the uterus andl irrigation leaving the visceralperitoneum open
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