Guidelines for laparoscopic total hysterectomy
Anesthesia: general anesthesia
Position: lithotomy position (bilateral shoulders immobilized with shoulder rests)
Instruments: workstation, laparoscopic system, suction, electric knife
Dressings: dressing bag, mid sheet, gynecologic mid sheet, spare surgical gowns
Instrument kit: dissection kit, lifting cup, a-style kit, yin pulling hook, gynecological laparoscopic instruments, optical test tubes, gynecological bipolar, ultrasonic scalpel, LC wire, Kangi 5mm needle holder
Others: tripods, gel pads, humanoid quilts, restraining belts, shoulder rests
Disposable consumables: sharp blade; large infusion set; 1#, 4#, 7# mousse line; suction connecting tube; electro-knife.
High-value consumables: absorbable 2-0○; 20ml sodium hyaluronate; uterine wire; absorbable 3-0○. Barb wire 1/2/3 0○ ready; Conkey #5, #10, #12 thwart card ready

I. Circulation:
1, establish intravenous access, select the right upper extremity for infusion, closely monitor vital signs, monitor temperature every 2 hours and record.
2、When the body position is placed, prevent injury to popliteal nerve and avoid excessive stretching.
3、When using the electric knife, check whether the patient has contact with metal objects to prevent electric burns.
4、Pay attention to the protection of patient's privacy during surgery and keep the patient warm in time.
Second, hand washing:
1、Check the expiration date of sterile bag and disposable items before going on stage.
2、Check the integrity of instruments after going on stage, and do three counts with the traveling nurse.
3、Strictly observe the rules of aseptic operation during operation and keep the specimen properly.

Laparoscopic total hysterectomy cooperation
1、Sterilize the skin, spread the towel, establish pneumoperitoneum
Sterilize the skin with iodine by handing the sterilizing forceps, and spread the sheet by handing the sterile towel routinely. Sterilize the umbilicus with ethanol cotton balls, lift up the abdominal wall with 2 toweling forceps, and place the file card with sharp blade or pneumoperitoneum puncture needle in order.
2、Transvaginal insertion of vaginal hooks to open the vagina, reveal the cervix, clamp the anterior lip of the cervix, sterilize the cervix and insert the cervical probe to detect the size and depth of the uterus, insert the uterus lifter, pass the vaginal hooks to open the vagina to reveal the cervix, hand the cervical forceps to lift the clamps, pass the skin wipers to clamp the iodine-vapor-sterilized cotton balls, hand the cervical probe, and pass the uterus lifter.
3、Identify and separate the ureter: pass the luminal curved forceps.
4、Cut off the round ligament and open the broad ligament: pass bipolar electrocoagulation or ultrasonic knife to cut off the round ligament of the uterus, pass scissors to cut open the anterior lobe of the broad ligament to the peritoneum of the bladder reflex.
5、Cut off the ovarian ligament and fallopian tube: pass the laparoscopic bipolar electrocoagulation to coagulate the fallopian tube and ovarian ligament, pass the laparoscopic scissors to cut it at the electrocoagulation place.
6、Separation of bladder: Lift up the peritoneum above the bladder with curved forceps and bluntly separate the bladder.
7. Resection of the uterine body at the level of the uterine isthmus above the uterine vessels: the uterine body is resected with a laparoscopic monopolar hook or ultrasonic knife, and temporarily placed in the uterine rectal fossa. The cervical stump is hemostatized by electrocoagulation, and the cervical stump is closed by passing a laparoscopic needle and No. 1 absorbable suture.
8、Removal of the uterine body: the left lower abdominal puncture hole was dilated to 15mm or 20mm by the No.11 knife, and the uterine body and fibroid were rotary cut with the uterine rotary cutter.
The uterine body and fibroid will be cut into strips and taken out one by one.
9、Flush the pelvic cavity and stop the bleeding: pass the laparoscopic needle and hold it, No.2/0 absorbable thread will be used to close the peritoneum of the bladder reflex and the posterior peritoneum with continuous suture to cover the cervical stump, and then count the instruments, gauze, cotton balls and suture needles.
10、Close the pneumoperitoneum, withdraw the carbon dioxide gas from the abdomen, withdraw the file card, take out the laparoscope, surgical instruments and file card.
11、Suture the incision, cover the incision, 3-0 angle needle with thread to close the skin, cover the incision after operation.