Table 2 Surgical treatment protocol for a TLH, total laparoscopic hysterectomy

Preoperatively thrombosis prophylaxis is given

Preoperative antibiotic is given at least 15 min before skin incision;

Positioning of the patient in lithotomy position.

Insufflation of CO2 and placing of the troicarts (4).

Abdominal washing for cytology.

Bipolar coagulation or sealing of the round ligament, cutting with monopolar scissors. Opening of the peritoneum of the bladder and the pelvic sidewall.

Bipolar coagulation or sealing of the infundibulopelvic ligament, cutting with monopolar scissors.

Placing the vaginal tube (the Mc Cartney tube). Preparation of the bladder off the vagina.

Skeletting the uterine vessels, coagulation or sealing of the vessels, after identification of the ureter.

Coagulation or sealing and cutting of the sacrouterine ligaments.

Cutting the vaginal wall on the rim of the vaginal tube. Keeping the ureter in sight.

Taking out the uterus. Closing of the vaginal cuff by abdominal or vaginal stitching.