Hysterectomy for 400 gr Uterus

This video shows the technique of laparoscopic hysterectomy. Hysterectomy is a symmetric procedure so all the steps are bilaterally performed and the assistant should do on the right side what the operator does on the left side with his left hand.

The first step is the section of the round ligament and the opening of the anterior leaf of the broad ligament. The vesico-uterine space is prepared by blunt dissection starting from the lateral avascular space above the uterine artery. The posterior leaf of the broad ligament is opened under the adnexa. The ureter is below this peritoneal opening. The utero-ovarian ligament is then transected.

Salpingectomy can be performed in this moment or at the end of the hysterectomy after the removal of the uterus before the closure of the vagina.
The posterior peritoneum is cut at the level of the utero-sacral ligament torus were is possible to see the manipulator cup delineating the posterior vaginal fornix. The uterine vessels are desiccated and cut.
hen are cut the connective fibers of the pericervical ring. The vagina is cut with the monopolar hook at the level of the manipulator.