From Complexity to Clarity: Fellows’ perspective on Comprehensive Canopy Concept-‘The 3 Step Technique’ of Total Laparoscopic Hysterectomy
Jain Nutan, Sureddi Priyanka, Srivastava Sakshi, Gulati Divyanee, Sareen Shweta, Jain Vandana, Mann Sonika, Agarwal Chetna, Singh Shalini, and Bayya S Prasanna
Total Laparoscopic Hysterectomy (TLH) is pivotal in gynecological surgeries, offering
advantages like decreased blood losses, faster recovery, shorter operative time and reduced
hospital stays.
The Comprehensive Canopy Concept: ‘The 3 Step Technique’ emerges as a three-step
strategy for streamlining TLH procedures in complex cases, characterized by extensive
bladder adhesions and ventrifixed uterus.
As fellows under the guidance of a distinguished gynaecology laparoscopic surgeon, we
recount the evolution of this approach. The first step challenges conventional norms by
advocating for a posterior approach to uterine artery, dissection and ligation before bladder
dissection. The second step involves meticulous dissection to create a bloodless uterovesical
space creating a bladder canopy. The culmination of this technique lies in the third step,
employing an anterior approach to dissect and coagulate the contralateral uterine artery.
As fellows, we share our experience in adopting the Comprehensive Canopy Concept: ‘The
3 Step Technique’ emphasizing its positive impact on surgical outcomes in densely adherent
bladder and patient care in cases of complex TLH. This technique not only transcends
traditional approaches but also addresses persistent challenges, offering a systematic
approach that ensures safety and reproducibility.
