TOTAL LAPAROSCOPIC HYSTERECTOMY

1. E-mail : [email protected] 1
TOTAL LAPAROSCOPIC HYSTERECTOMY
THE WAY WE DO IT
TECHNIQUE, TOOLS AND VIDEO PRESANTATION
DR. MOHAMMAD ABDUL QUAYYUM
FCPS
Chief Consultant (Gynae),
Gynaecological Endoscopic Surgeon,
Feni Private Hospital, Feni, Bangladash

2. E-mail : [email protected] 2
Introduction
In 1989 Harry Reich performed 1
st
Total Laparoscopic Hysterectomy (TLH).
OriginalOperationhasnotchangein
anymajordegree.
Howevertechniquesandtoolsare
changedforsafeoperation.
Duringoperationthemainproblems
are:
InjurytoUreter,Bladder,Rectumetc.
MaintenanceofPnemo-peritonium.

3. E-mail : [email protected] 3
Introduction (cont.)
Thisproblemsareminimizedby
verysimple,safeandeasily
availabletools.
ThenewsimplifiedTLHtechnique
istheintrafascialhysterectomy
donebycircumferentialvaginal
incisionabovetheattachmentof
utero-sacralligaments.

4. E-mail : [email protected] 4
Objective
Today I demonstrate a video
presentation showing TLH by
using Kleppinger bipolar forceps .
Purandare uterine manipulator
with a very simple device (Mineral
water bottle cap) usedas vaginal
delineator to cut the vaginal vault.

5. E-mail : [email protected] 5
Materials & Methods
FromFeb2005toAugust2008I
performed505LHofwhich362
wasTLH.
UnderGAinmodifiedlithotomy
positiona“0”-degre 10mm
telescopewasusedatthe
umbilicalport.Twoleftlateral
andonerightlateralportsfor
accessories.

6. E-mail : [email protected] 6
Materials & Methods (cont.)
Ionlyusedkleppingerbipolarforceps
forcoagulation&desiccationof
vessels.
Mineralwaterbottlecapwith
Purandareuterinemanipulatorused
ascervico-vaginaldelineator.
Pneumoperitoneumwasmaintained
bysterilewetspongevaginalpack.

7. E-mail : [email protected] 7
Laparoscopic tools
Kleppinger bipolar forceps (Creative).

8. E-mail : [email protected] 8
Laparoscopic tools (cont.)
Purandare uterine manipulator.
Mineral water bottle cap (Cervico-vaginal delineator).
Sterile wet sponges (Pnuemoocclutor).

9. E-mail : [email protected] 9
Application of uterine
manipulator with mineral water
bottle cap( cx. Delineator).

10. E-mail : [email protected] 10
Posterior laparoscopic view

11. E-mail : [email protected] 11
Anterior laparoscopic view

12. E-mail : [email protected] 12
The inside story

13. E-mail : [email protected] 13
Colpotomy of TLH (16 wks cervical fibroid).

14. E-mail : [email protected] 14
Colpotomy of TLH (Adenomyosis).

15. E-mail : [email protected] 15
Indications of TLH (n-362).Chronic
PID
55%
DUB
24%
Adnex.
mass 4%
Fibriod
6%
Other
5%
Endrom
etriosis
6%

16. E-mail : [email protected] 16
Results & Conclusion
Noevidenceofvisceralor
vascularinjuryorimmediate
post-operativebleeding.
Veryminimumgasleakageafter
colpotomy.
Totalcompletionofoperation
within40-90minutes.
Onlyone(0.25%) caseof
intraoperativebladderinjury
managed by intracorporeal
suturing.

17. E-mail : [email protected] 17
Results & Conclusion (cont.)
Onlytwo(0.55%)casesof2
nd
weeks
postoperativeuretericfistulamanaged
byurologist.
Four(1.1%)caseswereconvertedto
lapratomyduetopoorcaseselection
Nobowelinjuries.
Goodpostoperativerecoverywithin06
hours.
Dischargedforhomeafter24-48
hours.

18. E-mail : [email protected] 18
At the end we can say
The simplified technique of
TLH is simple, safe, least
traumatic & highly illustrative
intrafascial hysterectomy
carried out successfully by
very simple tools.

19. E-mail : [email protected] 19
Thank You