Because total laparoscopic hysterectomy (TLH) is technically challenging, laparoscopic-assisted vaginal hysterectomy is often the operation of choice, even in patients in whom it may not be successful. To encourage greater performance of TLH, I developed a technique and instrumentation that should enable gynecologists to do the operation successfully more often. The system consists of a pneumo-occluder and a cup, combined with a uterine manipulator. The cup, which is both visible and palpable, is placed over the cervix to delineate vaginal fornices, thus ensuring sale desiccation and a voiding ureteral dissection. Acceptable opera ting times allow TLH to be combined with other procedures, including excision of endometriosis, colposuspension, and enterocele repair.
