TLH 36 3eek Fibroid

In this comprehensive surgical guide, we delve into the complexities and techniques involved in performing Total Laparoscopic Hysterectomy (TLH) on a 36-week fibroid uterus post two previous C-sections. With the fibroid uterus filling the whole abdomen and extending close to the liver, this procedure comes with its challenges. *Key Insights:* Despite the significant size, the procedure is manageable due to the consistent number of pedicles.

A little manipulation provides access to the pedicles, though care is essential to handle the more torturous vessels anticipated in each one.

Previous C-sections increase the difficulty of separating the bladder from the cervix due to limited exposure.

Noteworthy is the puckering of the bladder by dense fibrous tissue, requiring precise sharp and blunt dissection for separation.

Given the uterus size, an elongated cervix suggests larger transverse cervical and uterosacral ligaments, which need careful handling. 

Join us as we explore these crucial surgical steps, providing insights and guidance for tackling such intricate cases effectively.