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An intra-abdominal pressure of 25mmHg was achieved by insufflation of Carbon Dioxide and 10 mm primary trocar was inserted supra-umbilically. The distance from the umbilicus varied with the size of the uterus. After insertion of a 10 mm telescope, the abdomen was inspected for injuries at entry. Three secondary 5 mm ports were introduced, two ports on left lateral side while the third port was on right side. (Picture 1) All secondary ports were introduced under direct vision. Myoma screw attached to fundus was used to manipulate the uterus. (Picture 2)

Total laparoscopic hysterectomy : an achievable reality throughout Sri Lanka?