Fig. 2

Total laparoscopic hysterectomy (TLH). a Multifibroid uterus, b dissection of the left round ligament, c preparation of left uterine vessels, d presentation of right uterine vessels, e ultrasound coagulation and separation of right uterine vessels, f ischemic uterus elevated by the uterine manipulator according to Mangeshikar, g vaginal delineation line on the ceramic cap of the Mangeshikar manipulator, h separation of cervix from vagina using the monopolar hook, i the cap becomes visible in the vaginal fornix, j continuous dissection of uterus from vagina, k extraction of a 210-g uterus from vagina and l reinsertion of the manipulator tube with ceramic cap to keep the pneumoperitoneum, closure of vaginal stump with a continuous suture and two corner sutures. To prevent enterocele formation, the sacrouterine ligaments are attached to the vaginal stump