From Complexity to Clarity: Fellows’ perspective on Comprehensive Canopy Concept-‘The 3 Step Technique’ of Total Laparoscopic Hysterectomy

Abstract

Total Laparoscopic Hysterectomy (TLH) is pivotal in gynecological surgeries, offering advantages like decreased blood losses, faster recovery, shorter operative time and reduced hospital stays. The Comprehensive Canopy Concept: ‘The 3 Step Technique’ emerges as a three-step strategy for streamlining TLH procedures in complex cases, characterized by extensive bladder adhesions and ventrifixed uterus. As fellows under the guidance of a distinguished gynaecology laparoscopic surgeon, we recount the evolution of this approach. The first step challenges conventional norms by advocating for a posterior approach to uterine artery, dissection and ligation before bladder dissection. The second step involves meticulous dissection to create a bloodless uterovesical space creating a bladder canopy. The culmination of this technique lies in the third step, employing an anterior approach to dissect and coagulate the contralateral uterine artery. As fellows, we share our experience in adopting the Comprehensive Canopy Concept: ‘The 3 Step Technique’ emphasizing its positive impact on surgical outcomes in densely adherent bladder and patient care in cases of complex TLH. This technique not only transcends traditional approaches but also addresses persistent challenges, offering a systematic approach that ensures safety and reproducibility