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Transcript of one day hysterectomy
Minimally Invasive Vaginal Hysterectomy
NEED OF THE TIME
DR. KAWITA BAPAT
One Day hysterectomy
BAPAT HOSPITAL INDORE
One Day hysterectomy
“Technological change is like an axe in the hands of a pathological criminal.”
Albert Einstein
One Day hysterectomy
Hysterectomy • More than half a million hysterectomies/year
significant cost to healthcare system• By age 60
one in three women• Majority for benign indications
fibroids
bleeding
endometriosis
pelvic pain
One Day hysterectomy
Evolution Total abdominal hysterectomy
Total vaginal hysterectomy
Laparoscopially-assisted vaginal hysterectomy
Laparoscopic supracervical hysterectomy
Total laparoscopic hysterectomy
Minimally invasive vaginal hysterectomy
One Day hysterectomy
Goal
• What should be the new selection criteria
• What are the Challenges
• What is the Technique
• What are the new instrumentation
• What is the fun
One Day hysterectomy
Vaginal Hysterectomy
• most favourite procedure
developed in the past
• need not to be a procedure of the past
• We cannot allow it to die
• We are indeed vaginal surgeons trained in vaginal surgery
• we need to keep the procedure alive
One Day hysterectomy
Evolution in Electro surgery
Mono polar instrumentation to
conventional bipolar instrumentation to
now advanced bipolar instrumentation
Improved traditional bipolar
• vessel sealing• bipolar cutting• tissue impedance feedback• improved outcome in terms of the tissue effect
One Day hysterectomy
Modern Technology
One Day hysterectomy
General principle Classical steps of conventional surgery
+
Three new principle
1.only 2 other instruments
2.Application of clamp close to uterus
3.No traction
One Day hysterectomy
Sequence of operation
• vaginal circumferential cut around cervix
• Haemostasis around cervix
• haemostasis and additional amputation of uterine vessels
• Amputation of uterus at adnexa
• Adnexectomy with clamp
• Occlusion of vaginal vault
One Day hysterectomy
Technical challenges to the vaginal approach:
• Exposure • Haemostasis• Entry into the cul-de-sac• Large uterus• Ureteral injury• High adnexa
One Day hysterectomy
criteria in determining the route for hysterectomy
• level of suspicion for malignancy
• presence of an adnexal mass
• vaginal access
• assessment of the mobility of the uterus
• what the size of the uterus
• previous caesarian section.
One Day hysterectomy
Entry into the cul-de-sac
stay within the uterus
don’t abort
(If you cannot enter anteriorly
or even posteriorly)
at some point,uterus will come down and present itself
So delay entry until you have good dissensus and visualization
One Day hysterectomy
Large uterus
• Bifurcation of uterus
• Amputation of cervix
• Make uterus pear shape to apple shape
• morcellation technique
One Day hysterectomy
To avoid Uretral injury
• Mobilize bladder pillars superiorly
and laterally
• perform cystoscopy
present inadvertent
occult kinking of the ureters
bladder injury
One Day hysterectomy
• Thermal hemostasis
Need three steps• Positioning of clamp• Removal of clamp • Cutting with scissors
• Classical hemostasis with sutures
• Need six steps • Positioning of the clamp
• Severing of the pedicle using scissors
• Placing the suture with needle holder
• Knotting
• Removal of forceps
• Cutting of the suture with scissors
One Day hysterectomy
Prevention of accidents
1.Burns
Skin and mucosa
Positioning of clamp
Suctioning of surgical smoke
2. Thermal necroses at the ureter
3. Thermal wounds of digestive tract
4.Bleeding
Immediate & Secondary
One Day hysterectomy
ligature vessel sealing system
• low voltage
• high current
• Impedance feedback
• optimal pressure
One Day hysterectomy
Vessel sealing technology
• Ensures
reliable, Consistent
isolate vessels• thermal spread predictable • less energy delivery• the pedicles are smaller and therefore the
steam effects are much less lateral to the instrument
• . No Sticking and charring, reliable sealsOne Day hysterectomy
OCCLUSION OF VESSELS
Mechanical
Flattening
Compression
Thermal
Dehydration of tissues
Destruction of proteins
Hardening of the collagen One Day hysterectomy
Benefits of tissue fusion system
consistent control of energy delivery
zones are more flexible stronger
greater reduction of thermal spread
less charring and sticking
One Day hysterectomy
Reduction of pain• Good psychological preparation
• The multimodal anesthesia
• Non aggressive operative technique
• No forcible pulling of pedicle and ligaments
• Ensuring hemostasis through thermo fusion
One Day hysterectomy
Impact on pain Thermal haemostasis
• Reduces inflammatory and painful events
• Absence of necrotic tissue and foreign bodies
One Day hysterectomy
Technical limitations with laparoscopy
• counter intuitive hand movements
• unsteady images and big learning curves
• inefficient electrosurgical tools
One Day hysterectomy
MIVH FAST
NO CO2LATEST
RELABLEPAINLESS
SUTURELESSCONVIENIENTBLOOD LESS
LESS OT TIMECOST EFFECTIVE
EARLY RECOVERYLESS RECOVERY TIME
LESS DURATION OF STAYEXPERTISED TECHNIQUE
WORLD WIDE ACCEPTANCEINTERNATIONALLY ACCLAIMED
LESS DURATION OF ANAESTHESIANOT GOING THROUGH SEVEN LAYERS OF ABDOMEN
One Day hysterectomy
MIVH Height of cost cutting
One Day hysterectomy
CONCLUSION
great procedure
Future Is Here
One Day hysterectomy
Summary
• Good procedure
• Develop new criteria for selecting patients
• Think of utilizing new technology
and instrumentations
• For the benefit of your patients
and also for yourself.
One Day hysterectomy
One Day hysterectomy
Sufficiently advanced technology is
indistinguishable from magic
Thankyou