2. Total Laparoscopic Hysterectomy Making Easy- The Technique and Tools :- A 8 -Year Experience Dr. Mohammad Abdul Quayyum MBBS, FCPS Consultant (Gynae) Gynaecologcal Endoscopic surgeon Feni Pvt Hospital, Bangladesh E-mail : quayyum1959@gmail.com1

3. November 7, 2010, Recommendation of the AAGL – Most Hysterectomies Should be Performed Vaginally or Laparoscopically E-mail : quayyum1959@gmail.com2

4. Introduction Laparoscopic techniques are being used increasingly more in gynecologic surgery In 1989 Harry Rich performed 1 st Total Laparoscopic Hysterectomy ( TLH). Original Operation has not change but techniques and tools are changed for safe operation. During operation the main problems are: Absence of landmarks. Injury to Ureter, Bladder and Rectum etc. Maintenance of Pnemo-peritonium. E-mail : quayyum1959@gmail.com3

5. HOW TO OVER COME THIS PROBLEMS The Q-Colpotomizer™ system (Simplified.TLH.technique) - A very simple, safe and easily available tools. E-mail : quayyum1959@gmail.com

6. Differents uterine manipulators Differents uterine manipulators E-mail : quayyum1959@gmail.com5

7. Purandare uterine manipulator Tintara uterine manipulator Q- Colpotomizer cup – 3, 3.5 4 cm Pneumo-occluder- sterile wet sponge- 7.5 x12 cm size Q-Colpotomizer™ system Purandare uterine manipulator Tintara uterine manipulator Q- Colpotomizer cup – 3, 3.5 4 cm Pneumo-occluder- sterile wet sponge- 7.5 x12 cm size E-mail : quayyum1959@gmail.com6

8. Video presentation showing techniques and tools of TLH :- Video presentation showing techniques and tools of TLH :- Purandare uterine manipulator. Q- Colpotomizer- Cup. P Purandare uterine manipulator. Q- Colpotomizer- Cup. Pneumo-occluder - 3-4 pieces sterile sponge wet E-mail : quayyu959@gmail.com7

9. Laparoscopic View E-mail : quayyum1959@gmail.com8 Anterior Laparoscopic ViewPosterior Laparoscopic View

10. The Inside Story (TLH) E-mail : quayyum1959@gmail.com9

11. Intraoperative bladder injury

12. Mean age (range)- 47.3 yrs (26–62 years) successful TLH - 1018 (99.4.%) Very minimum gas leakage. Six (0.6 %)cases were converted to Laparotomy. Mean operating time was 62 (24–175)min Intraoperative bladder injury- 1. Uretero-vaginal Fistula - 1. Mean hospital stay was 2.3 days (1–5). Result January 2008 to December 2015= 1024 TLH

13. Thank You E-mail : quayyum1959@gmail.com 12 Conclusion At the end we can say The simplified technique of TLH is simple, safe, least traumatic & highly illustrative intrafascial hysterectomy carried out successfully by the Q-Colpotomizer™ system associated with a high success rate and very low morbidity.