Total Laparoscopic Hysterectomy (TLH) is a procedure where the uterus and cervix are removed through four minor abdominal incisions. This article explains the ideal ergonomic port position in total laparoscopic hysterectomy.

Laparoscopy

Laparoscopy started with a ‘zero-degree’ telescope. It had a linear vision. It was difficult to view all abdomen, hence umbilicus was selected as a port of entry and used for the telescope.

The laparoscopy advanced meanwhile and new developments in camera and telescope were designed to meet the extra needs.

Removal of the big tumours

In cases where a big tumour was operated, the zero-degree telescope could not provide the necessary vision. This prompted the development of a 30-degree and then a 45-degree telescope. This made the surgeon get a very good view from different angles.

Ergonomic port position

The assistant holds the camera from the opposite side. The surgeon and the camera person are facing each other. This needs two monitors, one for the surgeon and one for the assistant. If this is not available, the camera person has to see back, this is not very comfortable for him.

Ideally, the surgeon, the organ and the screen should be in one line, as it is in open surgery. This makes the surgeon comfortable. The camera person should also have the same position to show the surgeon, to give the surgeon a desirable view.

The cameraperson’s movements should not interfere with the surgeon’s movements.

Advantages of this method

1. In this new method, the camera person stands on the same side as the surgeon, just behind him. This is done by making another port for the camera at Palmer’s point.
2. The central port, a versatile one to approach anywhere in the abdomen is used for the dominant hand instrument.
3. The cameraperson can show the operating site better.
4. The surgeon can use a central port, which reduces the need to operate from a contralateral port, which is not as convenient as a central port.
5. Ideally, the surgeon’s arm should not abduct more than 30 degrees for effortless movements. This is achieved by this simple method.

Position of the surgeon, cameraperson, monitor and patient

Disclaimer- The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of M3 India.

About the author of this article: Dr Pandurang Rotithor is a practising gynaecologist from Pune.