Laparoscopic Hysterectomy Instruments and Devices: What an OR Needs for TLH

Imaging: telescope, camera and light

TLH is performed on a tower with a laparoscope, a camera head, a light source and a monitor. Image clarity at the periphery matters because the surgeon works in the deep pelvis near the ureters, bladder and rectum. The Richard Wolf PANOVIEW ULTRA telescope generation is optimised for Ultra HD and 4K, with ED glass lenses, lead- and arsenic-free fibre optics and a larger aperture that transmits more light; it uses the same light cable as 10 mm telescopes.

Ask whether the telescope withstands repeated autoclave cycles without loss of transmission; the manufacturer states hardly any transmission loss after 500 autoclave cycles for PANOVIEW ULTRA. Keep a spare telescope of each angle you use, typically 0 and 30 degrees.

Also consider the ergonomics for the operator and assistant: monitor height, boom or table position, and cable management all affect fatigue during a long pelvic case.

Access: trocars and ports

A typical TLH uses an umbilical port for the optic and three or four additional ports. Reusable trocar systems include sleeves with different diameters and safety designs with automatic locking. The REDA laparoscopy range offers trocar sleeves from 3.5 to 20 mm, safety trocars with auto-lock, reducers and autoclavable 5 and 10 mm laparoscopes with 0 and 30 degree views.

Match the size of ports to the instruments, the retrieval device and any morcellator you plan to use. Check seals and valves, since leakage of pneumoperitoneum disturbs the work.

Grasping, cutting, suturing and TLH gynecology instruments

The hand-instrument set includes atraumatic graspers, dissecting forceps, scissors, needle holders for vaginal cuff closure, a suction-irrigation device and bipolar forceps. REDA's modular instruments join working insert and sleeve with a CLICK snap-action coupling and have carbon handles with ratchet, 360 degree rotating head and HF connector for 3, 5 and 10 mm shafts.

Modular instruments simplify cleaning, because the insert can be separated from the sleeve. Ask how the cleaning channels are accessed and how many inserts the standard set contains.

• Atraumatic and toothed graspers
• Scissors and dissectors
• Needle holders for suturing the vaginal cuff
• Suction-irrigation and bipolar forceps
• Light cable and spare instruments

Uterine manipulator and vessel sealing

A uterine manipulator with a colpotomy cup is a standard part of TLH, because it presents the uterus and delineates the vagina for the colpotomy. Select the system according to the guide to uterine manipulator types.

For haemostasis, many teams use a vessel-sealing instrument. The BOWA ERGOseal has a Maryland jaw that dissects, seals and cuts vessels up to 7 mm, with 22 mm sealing and 20 mm cutting length, separate triggers for sealing and cutting and a shaft that rotates 360 degrees. It is paired with a compatible BOWA generator; see our note on vessel sealing in laparoscopic hysterectomy.

Whatever device is chosen, check generator compatibility and plug types before purchase, and confirm that staff have been trained on the specific instrument and its settings.

Specimen removal and next steps

Once the uterus is detached it is removed through the vagina or, if too large, in a bag with contained morcellation. See our guide to the tissue retrieval bag for selection criteria. All the instruments should be listed in a standard TLH set with a count sheet.

Beckfinity can help your department build a specification for TLH instruments from the BOWA, REDA and Richard Wolf portfolios. Use the contact page to ask for a consultation.

For the vaginal cuff, specify the suture material and needle holders that your surgeons prefer, since these are rarely part of a basic hardware set but are essential on the day.