Surgical Steps for Total Laparoscopic Hysterectomy with Bilateral Salpingo-Oophorectomy

Preoperative Evaluation and Abdominal Exploration

Perform thorough visual evaluation of the peritoneal, diaphragmatic, and serosal surfaces, including inspection and palpation of abdominal organs, to identify any suspicious lesions or abnormalities, as recommended by the National Comprehensive Cancer Network 1
Obtain peritoneal washings for cytology to assess for any malignant cells, as suggested by the National Comprehensive Cancer Network and supported by evidence from Praxis Medical Insights 1, 2, 4
Biopsy any suspicious lesions to exclude extrauterine disease, as recommended by the National Comprehensive Cancer Network 1

Identify and ligate the round ligaments bilaterally, and complete excision of the lumbar-ovarian vessels (infundibulopelvic ligaments) bilaterally for removal of tubes and ovaries, as described by Praxis Medical Insights 2, 3
Identify, ligate, and divide the uterine vessels, as described by Praxis Medical Insights 2
Perform total hysterectomy with complete removal of the uterus and cervix, and remove fallopian tubes and ovaries bilaterally, as recommended by the National Comprehensive Cancer Network and Praxis Medical Insights 2, 5

Close the vaginal cuff laparoscopically, as described by Praxis Medical Insights 2, 3
Avoid morcellation outside of endoscopic bags, as this carries high risk of worsening prognosis if malignancy is discovered post-operatively, as warned by the Annals of Oncology 6
Document precise operative findings, including tumor size, location, depth of invasion, and histologic features, as recommended by the National Comprehensive Cancer Network 1
Record quality of excision margins and completeness of procedure, as described by Praxis Medical Insights 2, 3

Laparoscopic approach results in shorter hospital stays and fewer moderate-to-severe postoperative complications versus open procedures, as reported by Praxis Medical Insights 4