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Laparoscopic hysterectomy: removal of a large (1300g) uterus
Some believe that laparoscopy is almost impossible to perform in cases of very big uterus or large adnexal masses that obstruct our view to the pelvis. However, if the same surgical steps are always followed and a specific strategy is determined, it is feasible and safe to choose laparoscopy even in the case of large organs. In this video, we present the case of a 45-year-old patient with a large fibromatous uterus, suffering from abdominal discomfort and bleeding. The patient was anemic and decision was made to perform a laparoscopic total hysterectomy. With the appropriate surgical steps and some safety tips, the operation took place quickly and with success. The weight of the specimen was 1300g.
A Wattiez, P Trompoukis, J Nassif, B Gabriel
Surgical intervention
8 years ago
5352 views
54 likes
0 comments
10:21
Laparoscopic hysterectomy: removal of a large (1300g) uterus
Some believe that laparoscopy is almost impossible to perform in cases of very big uterus or large adnexal masses that obstruct our view to the pelvis. However, if the same surgical steps are always followed and a specific strategy is determined, it is feasible and safe to choose laparoscopy even in the case of large organs. In this video, we present the case of a 45-year-old patient with a large fibromatous uterus, suffering from abdominal discomfort and bleeding. The patient was anemic and decision was made to perform a laparoscopic total hysterectomy. With the appropriate surgical steps and some safety tips, the operation took place quickly and with success. The weight of the specimen was 1300g.
Surgical strategies and techniques for difficult hysterectomy
In gynecologic surgery, hysterectomy is the most important procedure. Sometimes, however, hysterectomy can be a very difficult and challenging operation, and even more so if performed laparoscopically. Situations that distort the pelvic anatomy such as large fibroids, severe endometriosis, postoperative adhesions and morbid obesity make surgery much more difficult. Dr Lee analyses in a very didactic way all these situations, gives valuable directions and surgical strategies in order to overcome difficulties, and uses specific rules to obtain the best result as much safely as possible. Very useful are the different approaches, namely anterior, posterior and lateral, for patients with big fibroids, for adhesions and for fibrosis originating from severe endometriosis respectively.
T Lee
Lecture
9 years ago
3119 views
51 likes
0 comments
25:34
Surgical strategies and techniques for difficult hysterectomy
In gynecologic surgery, hysterectomy is the most important procedure. Sometimes, however, hysterectomy can be a very difficult and challenging operation, and even more so if performed laparoscopically. Situations that distort the pelvic anatomy such as large fibroids, severe endometriosis, postoperative adhesions and morbid obesity make surgery much more difficult. Dr Lee analyses in a very didactic way all these situations, gives valuable directions and surgical strategies in order to overcome difficulties, and uses specific rules to obtain the best result as much safely as possible. Very useful are the different approaches, namely anterior, posterior and lateral, for patients with big fibroids, for adhesions and for fibrosis originating from severe endometriosis respectively.
Laparoscopic hysterectomy with adnexectomy
This video demonstrates the technique of a total laparoscopic hysterectomy with adnexectomy. Our patient is a 44-year-old lady with Tamoxifen-induced endometrial hyperplasia, which failed to respond to medical treatment.
Umbilical incision is made on the left internal border to give a more aesthetic scar.
Direct entry is performed. The assistant helps to lift the abdomen while the surgeon directs the trocar perpendicularly towards the rectus sheath first, then directs it towards the pelvis. The midline port is inserted: this should be at a slightly higher level than the lateral ports for better ergonomics. The uterine manipulator has a rotating ceramic valve for opening the vagina and a set of rings to maintain the pneumoperitoneum. The procedure is started by coagulating and cutting the round ligament on the left and opening the broad ligament. The broad ligament is opened parallel to the infundibulopelvic ligament for adnexectomy and a window is made over the grey area. The posterior leaf of the broad ligament is opened towards the left uterosacral ligament. The anterior leaf of the broad ligament is opened towards the vagina by dissecting the space and coagulating and cutting the tissues in between. The dissection is continued until the uterine artery is reached. The left infundibulopelvic ligament is coagulated and cut. The same procedure is done on the other side. Bladder dissection is performed with the help of the assistant holding up the bladder and entering the vesicovaginal space. The bladder is dissected away, beyond the valve of the manipulator. The left uterine artery is coagulated and cut. The left uterosacral ligament is coagulated and cut. The right uterine vessels are coagulated and cut followed by the uterosacral ligament. The vagina is now cut against the valve of the manipulator using a monopolar hook. Bleeding points are coagulated with a bipolar forceps. The vagina is sutured in two layers using extracorporeal knots. The procedure is now complete and hemostasis is confirmed. This patient had a favourable postoperative outcome and was discharged on postoperative day 1.
A Wattiez, E Kovoor, J Nassif, I Miranda-Mendoza
Surgical intervention
10 years ago
10034 views
95 likes
0 comments
23:00
Laparoscopic hysterectomy with adnexectomy
This video demonstrates the technique of a total laparoscopic hysterectomy with adnexectomy. Our patient is a 44-year-old lady with Tamoxifen-induced endometrial hyperplasia, which failed to respond to medical treatment.
Umbilical incision is made on the left internal border to give a more aesthetic scar.
Direct entry is performed. The assistant helps to lift the abdomen while the surgeon directs the trocar perpendicularly towards the rectus sheath first, then directs it towards the pelvis. The midline port is inserted: this should be at a slightly higher level than the lateral ports for better ergonomics. The uterine manipulator has a rotating ceramic valve for opening the vagina and a set of rings to maintain the pneumoperitoneum. The procedure is started by coagulating and cutting the round ligament on the left and opening the broad ligament. The broad ligament is opened parallel to the infundibulopelvic ligament for adnexectomy and a window is made over the grey area. The posterior leaf of the broad ligament is opened towards the left uterosacral ligament. The anterior leaf of the broad ligament is opened towards the vagina by dissecting the space and coagulating and cutting the tissues in between. The dissection is continued until the uterine artery is reached. The left infundibulopelvic ligament is coagulated and cut. The same procedure is done on the other side. Bladder dissection is performed with the help of the assistant holding up the bladder and entering the vesicovaginal space. The bladder is dissected away, beyond the valve of the manipulator. The left uterine artery is coagulated and cut. The left uterosacral ligament is coagulated and cut. The right uterine vessels are coagulated and cut followed by the uterosacral ligament. The vagina is now cut against the valve of the manipulator using a monopolar hook. Bleeding points are coagulated with a bipolar forceps. The vagina is sutured in two layers using extracorporeal knots. The procedure is now complete and hemostasis is confirmed. This patient had a favourable postoperative outcome and was discharged on postoperative day 1.