Supracervical hysterectomy, bilateral salpingectomy, laparoscopic

• positioned in lithotomy position
• It is recommended to position both arms alongside the body (caution: use cotton wrapping when positioning with a cloth sling), or to position one arm on the assistant's side
• The legs should be adjustable in flexion and extension via the operating table control
• if necessary, use shoulder supports to prevent the patient from slipping on the operating table
• Attachment of a cervical adapter, e.g., a Hohl's bell

Creation of a capnoperitoneum is performed by inserting a Veress needle infraumbilically after a skin incision. Then, the optical trocar is introduced at the same location.

During laparoscopy, the inspection of the abdomen is performed, including the upper abdominal area, the diaphragmatic domes, the liver, the gallbladder, the stomach, and the omentum. Additionally, an inspection of the intestines and the peritoneum is conducted.

Subsequently, head-down positioning.

Placement of 2 additional 5 mm working trocars under direct vision.

The selection of the number and position of laparoscopic incisions is at the discretion of the surgeon and is based on their personal preferences as well as the specific requirements of the operation. Incisions are often chosen in the left and right lower abdomen or in the left lower and mid-abdomen (left periumbilical).

Procedure for incisions in the lower abdomen: Visualization of the inferior epigastric artery in the lateral umbilical fold. Laterally, the superficial vessels are visualized through diaphanoscopy (superficial circumflex iliac artery, superficial epigastric artery). Two fingerbreadths medial to the anterior superior iliac spine, in the vessel-free area, incision and insertion of a working trocar into the lower abdomen.

Procedure for incisions in the mid-abdomen (mostly left): Visualization of the inferior epigastric artery in the lateral umbilical fold. The superficial vessels are visualized through diaphanoscopy. Incision at the level of the navel and approximately 3 cm lateral to it. It is important to ensure that the incision is not too close to the optical trocar or in line with the working trocar of the lower abdomen, to avoid collision risk.

Procedure for suprapubic incisions: Preoperative placement of a urinary catheter to empty the bladder. 1-2 fingerbreadths above the symphysis, the superficial vessels are visualized through diaphanoscopy. Incision and insertion of the working trocar under direct vision.

Inspection of the pelvis, considering the uterus, both adnexa, the Douglas pouch, and the transperitoneal visualization of both ureters.

Grasp the distal part of the uterine tube and luxate it to better display the fimbrial funnel and the mesosalpinx. The uterus is mobilized to the left using the portio adapter to tension the structures in the area of the right pelvic wall. In the mesosalpinx, anastomoses of the tubal branch of the uterine artery and the tubal branches of the ovarian artery run. In the distal part, just before the fimbrial funnel, there is often a somewhat larger anastomosis. Bipolar coagulation in this area and then stepwise detachment of the tube from the right pelvic wall using scissors (or as in this video using Caiman, a bipolar vessel sealing instrument) while carefully sparing the right ovary. Bipolar coagulation of the tube in the course near the uterus and transection.

Depending on the operator's preference and the size of the findings, the uterine tube can be placed in a retrieval bag after detachment and retrieved through an incision extension from the left lower entry point. In the case of delicate tubes with unremarkable findings, e.g., in the context of sterilization, the tubes can be pulled out through the working trocar.