Get me images of total laporoscopic hysterectomy from bailey and love

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The content is in block13. Let me read the section around "Morcellation" and the hysterectomy content to find associated images.

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Let me now look further in the file for specific TLH (total laparoscopic hysterectomy) images and the hysterectomy-related sections:

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Let me search specifically for "total laparoscopic hysterectomy" or "TLH" in Bailey and Love, and also look earlier in the block for hysterectomy images:

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Let me search specifically for "TLH" and also look at the hysterectomy section more carefully, including looking around line 2886-2935 where hysterectomy management appears:

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"![" in /textbooks/9780367548117

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Now let me fetch all the images in the hysterectomy section of this block, including the area around line 2892 (Figure 87.19, 87.20) and the full figures list:

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I now have all the relevant images from Bailey and Love's that are associated with laparoscopic hysterectomy content. Let me fetch them all for display:

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I have found and retrieved all the laparoscopic hysterectomy-related images from Bailey and Love's 28th Edition (Chapter 87). Here they are:

Laparoscopic Hysterectomy - Bailey and Love's Short Practice of Surgery, 28th Edition (Chapter 87)

Important note: Bailey and Love is a general surgery textbook, so its gynaecology chapter does not include step-by-step TLH operative images. The textbook covers the topic conceptually and includes the following relevant figures:

Figure 87.20 - Laparoscopic View of a Uterine Fundal Fibroid

Intraoperative laparoscopic photograph showing a subserosal/fundal fibroid - the most common indication for laparoscopic (including total laparoscopic) hysterectomy.

Figure 87.21 - Diagram of Uterine Fibroid Locations

Anatomical diagram showing the uterus with fibroid positions: intramural, subserosal (pedunculated and sessile), and submucosal - key to understanding the surgical anatomy relevant to laparoscopic hysterectomy.

Figure 87.22 - MRI of Uterine Fibroids

Sagittal MRI showing a markedly enlarged fibroid uterus. MRI is used preoperatively to plan the route of hysterectomy (vaginal, abdominal, or laparoscopic).

Figure 87.19 - Pre-embolisation Angiogram of Left Uterine Artery

Pre-embolisation angiogram showing catheterisation of the left uterine artery and blood supply to a large fundal fibroid. Uterine artery anatomy is directly relevant to ligation of uterine arteries in TLH.

Summary: Bailey and Love's 28th Edition does not contain dedicated intraoperative step-by-step TLH photographs (the textbook covers the laparoscopic approach to hysterectomy mainly in the context of indications and technique principles). The images above are all the laparoscopic/gynaecological figures from Chapter 87 that relate to laparoscopic hysterectomy. For detailed operative step images of TLH, a dedicated gynaecology operative atlas (such as Berek & Novak's Gynecology, which is also in the library) would be a better source.

Shaw's Textbook of Gynaecology Te Linde's Operative Gynecology Sabiston — general laparoscopy For surgery i want steps for surgery

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Only Sabiston is in the library. Shaw's and Te Linde's are not available. Let me now search Sabiston for laparoscopic surgical steps and images, and also search the full library for TLH steps.

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Excellent! Schwartz's has TLH content, and Berek & Novak's has a full "Surgical Technique of Laparoscopic Hysterectomy" section. Let me read both simultaneously.

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Let me get the remaining images from Berek & Novak's (uterine artery ligation, colpotomy, vaginal cuff closure):

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I now have all the key images and surgical steps. Let me also get the uterine artery image that was referenced but not yet fetched:

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Library availability note: Shaw's Gynaecology and Te Linde's Operative Gynecology are not in the library. Only Sabiston is available - but Sabiston's chapter covers LAVH/TLH only briefly. The richest TLH operative content (with dedicated step-by-step surgical figures from the Cleveland Clinic) comes from Berek & Novak's Gynecology, which is in the library. Schwartz's Principles of Surgery also has a good hysterectomy steps figure. Both are presented in full below.

Total Laparoscopic Hysterectomy (TLH) - Surgical Steps & Images

Source: Berek & Novak's Gynecology (Chapter 27) + Schwartz's Principles of Surgery (Chapter 41)

PREOPERATIVE SETUP

Patient positioning: Dorsal lithotomy with legs in Allen/Yellowfin stirrups. Arms tucked. Egg-crate mattress to prevent sliding in Trendelenburg. No shoulder braces (brachial plexus injury risk).

Before first trocar:

Examination under anesthesia
Foley catheter inserted
Uterine manipulator placed (e.g., Koh colpotomizer or VCare device)
Oral/nasogastric tube inserted

STEP 1 - PORT PLACEMENT

Three lateral accessory ports + umbilical camera port. Ports placed ~8 cm from midline and ~8 cm above the pubic symphysis. The inferior epigastric vessels must be avoided - they run medial to the round ligament insertion at the deep inguinal ring and cannot be transilluminated.

Figure 27-23 Port placement and vascular anatomy for laparoscopic hysterectomy - Berek & Novak's Gynecology

Port positions (dots) relative to inferior epigastric, deep circumflex iliac, and femoral arteries.

STEP 2 - MESOSALPINX & ROUND LIGAMENT DIVISION

If the fallopian tubes are removed: coagulate and transect the mesosalpinx first, then the round ligament. The incision is carried anteriorly to create a bladder peritoneal flap by sharp dissection of the loose cervicovesical areolar tissue.

Figure 27-24 Ligation and transection of the mesosalpinx - Berek & Novak's Gynecology

STEP 3 - BROAD LIGAMENT & RETROPERITONEAL SPACE

Transect the round ligament and open the posterior broad ligament toward the uterosacral ligament. Open the retroperitoneal space and identify the ureter on the medial leaf of the broad ligament. The utero-ovarian ligament is coagulated and transected (ovary conserved) or the infundibulopelvic ligament is divided (oophorectomy).

Figure 27-25 Round ligament transected; posterior broad ligament opened toward uterosacral ligament - Berek & Novak's Gynecology

STEP 4 - UTERO-OVARIAN LIGAMENT DIVISION

With ovaries conserved: coagulate and transect the utero-ovarian ligament and its blood vessels. The posterior leaf of the broad ligament is now clearly visible.

Figure 27-26 Utero-ovarian ligament transected; posterior leaf of broad ligament exposed - Berek & Novak's Gynecology

STEP 5 - UTERINE ARTERY LIGATION (Key Step)

The uterus is torqued away from the uterine artery to be occluded. The posterior peritoneum is cut up to the uterosacral ligament to skeletonize the uterine artery. With the ureter clearly in view, the uterine artery is coagulated and transected at the level of the internal os. Repeated on the contralateral side.

Figure 27-27 With the ureter in view, the uterine artery is identified and coagulated - Berek & Novak's Gynecology

STEP 6 - COLPOTOMY (Distinguishes TLH from LAVH)

The anterior dissection is completed so the bladder is fully mobilised off the anterior fornix. Using the Koh colpotomizer (maintains pneumoperitoneum), monopolar cautery makes a circumferential colpotomy around the cervix. The uterus is then delivered vaginally or morcellated.

Figure 27-28 Monopolar cautery makes the colpotomy against the uterine manipulator - Berek & Novak's Gynecology

STEP 7 - VAGINAL CUFF CLOSURE

The vaginal cuff is closed laparoscopically (or vaginally) with interrupted or continuous delayed-absorbable suture. The uterosacral ligaments are incorporated into the vaginal angles (McCall culdoplasty) for apical support. Cystoscopy with IV fluorescein confirms ureteral integrity.

Figure 27-29 Vaginal cuff closed with uterosacral ligaments incorporated for vault support - Berek & Novak's Gynecology

Schwartz's Principles of Surgery - Hysterectomy Steps Diagram (Figure 41-12)

A complete 8-panel operative sequence (A-H) showing the full hysterectomy from initial exposure through vaginal cuff closure:

Figure 41-12 (A-F) Hysterectomy steps: initial anatomy, round ligament division, ovarian ligament, bladder reflection, uterine vessels, cardinal ligament - Schwartz's Principles of Surgery

Panels A-F: Uterus + bladder anatomy → Round ligament clamped → Ovarian/fallopian ligament divided → Bladder reflected → Uterine vessels identified → Cardinal ligament.

Figure 41-12 (G) Anterior colpotomy - Schwartz's Principles of Surgery

Panel G: Colpotomy - entry into the vaginal fornix.

Figure 41-12 (H) Vaginal cuff closure with cardinal ligament incorporation - Schwartz's Principles of Surgery

Panel H: Vaginal cuff closure incorporating cardinal ligament stumps.

Summary of TLH Steps

Step	Action	Key Point
1	Patient positioning + instrumentation	Uterine manipulator is essential
2	Port placement	Avoid inferior epigastric vessels
3	Mesosalpinx + round ligament division	Creates bladder peritoneal flap
4	Retroperitoneal dissection + ureter ID	Ureter on medial leaf of broad ligament
5	Utero-ovarian or IP ligament division	Depends on oophorectomy decision
6	Uterine artery skeletonization + ligation	Ureter must be visualised first
7	Colpotomy (circumferential)	Distinguishes TLH from LAVH
8	Uterus removal (vaginal or morcellation)
9	Vaginal cuff closure + McCall culdoplasty	Incorporate uterosacral ligaments
10	Cystoscopy	Confirm ureteral integrity

Sources: Berek & Novak's Gynecology (Chapter 27, Figures 27-23 to 27-29) | Schwartz's Principles of Surgery 11th Ed (Chapter 41, Figure 41-12)

Shaw's Gynaecology and Te Linde's Operative Gynecology are not currently in the library and could not be retrieved. The steps above from Berek & Novak's represent the gold-standard operative gynecology reference available.

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