If a uterus cannot be extracted vaginally during a LAVH, which instrument should be available?

In the context of a Laparoscopic Assisted Vaginal Hysterectomy (LAVH), if the uterus cannot be extracted vaginally, the morcellator becomes a critical instrument. This device is specifically designed to cut large tissue masses, such as the uterus, into smaller fragments that can be more easily removed through small incisions or the vaginal canal.

The morcellator's function is particularly useful in cases where the uterus is enlarged or there are other anatomical considerations that prevent its safe removal through the vaginal route. By using the morcellator, the surgical team can minimize the need for more invasive surgical approaches, thus preserving patient safety and promoting quicker recovery times.

While other instruments like the Harmonic scalpel and Enseal are effective for tissue cutting and sealing, they do not specifically address the challenge of tissue extraction. Ligature, on the other hand, is typically used for tying off blood vessels rather than cutting and facilitating extraction. Therefore, in scenarios where a uterine extraction cannot be completed vaginally, the morcellator is indispensable for effectively handling the situation.