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Big Uterus a Total Laparoscopic Hysterectomy with a Simplyfied Technique Report of 80 Cases
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Abstracts / Journal of Minimally Invasive Gynecology 15 (2008) S1eS159
Design: From January 2001 to December 2006, a total of 148 patients were reviewed and 130 patients with CISH were entered into the study. Patients: We investigated clinical factors, such as age, parity, transverse diameter of uterus, operation history, operation assistant, categorized groups of operation in sequence of operation date, pathology of uterus and operative time of surgery. The statistical assessment was used to find out the main factor determining the operative time of CISH. Measurements and Main Results: The mean operative time of CISH was 135.5 minutes and the mean transverse diameter of uterus was 7.22 cm. The main indications for CISH were uterine myoma or adenomyosis with dysmenorrhea, menorrhagia and vaginal bleeding. The operative time of CISH was affected by the transverse diameter of uterus and operation groups which were categorized in sequence of operation date. Conclusion: Mainly, pre-operative ultrasonographic evaluation of uterine transverse diameter could predict the operative time of CISH.
430 ‘‘The SGRH Technique,’’ a Method Evolved for Safer Total Laparoscopic Hysterectomy Marwah V, Bharadwaj P. Unit of Gynaecology Endoscopic Surgery, Department of Obstetrics & Gynaecology, Sir Ganga Ram Hospital, New Delhi, Delhi, India Study Objective: To evolve a technique for making Total laparoscopic Hysterectomy safer using Marwah’s uterine manipulator and lithotomy poles along with suturing of uterine vessels and vault closure (simulating abdominal hysterectomy for proper vault anchoring) and also keeping the use of thermal energy minimal. Design: Prospective analysis of 1600 cases of total laparoscopic hysterectomy using The Sir Ganga Ram Hospital Technique, for making it safer and better for the patients. Setting: Tertiary care teaching hospital. Patients: 1600 patients referred for Total laparoscopic hysterectomy for indications like Myoma uteri, severe endometriosis etc. Intervention: Total laparoscopic hysterectomy with or without adhesiolysis/ oophorectomy. Measurements and Main Results: Of the 1600 patients who underwent Total laparoscopic Hysterectomy for indications like myoma uteri (40%),Endometriosis (28%), DUB with previous LSCS (14%) and others(18%), the use of this technique reduced the procedure time, decreased complication’s rate and made recovery faster. Conclusion: Total Laparoscopic Hysterectomy using the SGRH technique has become safer and better for the patient and the evolution continues.
431 Big Uterus a Total Laparoscopic Hysterectomy with a Simplyfied Technique Report of 80 Cases Mota M. Endoscopic Gynecologic, Institute National of Perynatology, Mexico, DF, Mexico Study Objective: To Present a technique to made a Total Laparoscopic Hysterectomy in the big utures with a technique simple and safe to prevent morbility and reduce time to the surgery. Design: It Takes in The Institute National of Perynatology in patientes with big uturus size 20 cm and realiza total laparoscopic hysterectomy with the vertical zone technique and the Koh Cup. Setting: TLH and the Koh Cup. Patients: 80 patients with big uterus. Intervention: Total Laparoscopic Hysterectomy. Measurements and Main Results: It was made 80 TLH with mean time of 90 minutes with 80 cc of blood mean, no morbility mean time in hospital 24 hrs no infeccion of cuff.
Conclusion: This techynique is safe and superior to realize TLH in a big uterus.
432 Comparison of the Efficacy of the Pulsed Bipolar System and Conventional Bipolar Electrosurgery in Total Laparoroscopic Hysterectomy (TLH) Park S. Obstetrics and Gynecology, Hallym Medical University, Seoul, Republic of Korea Study Objective: We compared the safety and effectiveness of the pulsed bipolar system (Plasmakinetic; Gyrus Medical, Maple Grove, MN) and conventional electrosurgery (Kleppinger bipolar forceps: Richard Wolf instruments, Vernon Hills, IL) in total laparoscopic hysterectomy. Design: In this retrospective, randomized study, 80 women with benign gynecologic diseases scheduled for TLH were divided into two groups: one group underwent TLH with pulsed bipolar system and the second group underwent TLH with conventional electrosurgery. Outcome measures for both group were compared in terms of length of operation time, amount of blood loss, and the length of hospital stay. Measurements and Main Results: There is no difference in the mean operation time (150 þ 34.7 minutes vs. 159 þ 31.1 minutes, P 5 0.06) between in the pulsed bipolar system group and in the conventional electrosurgery group. The mean blood loss (478.2 þ 200.0 ml vs. 417.5 þ 153.4 ml, P 5 0.13) and the mean length of hospital stay (6.9 þ 1.2 days vs. 6.4 þ 0.5 days, P 5 0.06) were slightly greater in conventional electrosurgery group than those in the pulsed bipolar system group, although these differences were not statistically significant. No patients developed serious complications related either to conventional electrosurgery or to the pulsed bipolar system. Conclusion: Our findings indicate that the pulsed bipolar system is safe and effective as conventional electrosurgery, and in the hands of experienced surgeons, both the pulsed bipolar system and electrosurgery can be used safely in TLH.
433 Clinical Evaluation on 1234 Cases of Pelviscopic Assisted Vaginal Hysterectomy Park HM,1 Kim T,2 Lee ES,1 Rho HK.1 1Obstetrics & Gynecology, Yongsan Hospital College of Medicine Chung-Ang University, Seoul, Republic of Korea; 2Obstetrics & Gynecology, Korea University Ansan Hospital, Ansan, Gyeonggi-Do, Republic of Korea Study Objective: To report our experience with pelviscopic assisted vaginal hysterectomy (PAVH) and evaluate the advantages of PAVH. Design: Retrospective review of records. Setting: Obstetrics & Gynecology unit of Yongsan Hospital College of Medicine Chung-Ang University. Patients: 1234 patients who underwent PAVH from January 1994 to December 2003. Patients checked pap smear before operation. All of patients are benign condition of uterus. Intervention: Pelviscopic assisted vaginal hysterectomy (PAVH). Measurements and Main Results: The mean age was 44.6 6.5 years. The mean parity was 2.3 1.1. Tubal ligation was the most common previous abdominal surgery. Uterine myoma was the most common preoperative surgical indication and post operative diagnosis. The mean operation time was 109.6 42.0 minutes. The mean uterine weight was 209.2 105.5 gm. The mean hemoglobin change was 2.1 1.8 g/dL. The mean hospital stay was 7.5 1.1 days. The complication rate was 3.1%, bladder injury being the most common complication. Conclusion: Hysterectomy can be safely performed vaginally assisted by operative laparoscopy. The further development of laparoscopic instruments and skills will reduce limitations and complication of
Abstracts / Journal of Minimally Invasive Gynecology 15 (2008) S1eS159
Design: From January 2001 to December 2006, a total of 148 patients were reviewed and 130 patients with CISH were entered into the study. Patients: We investigated clinical factors, such as age, parity, transverse diameter of uterus, operation history, operation assistant, categorized groups of operation in sequence of operation date, pathology of uterus and operative time of surgery. The statistical assessment was used to find out the main factor determining the operative time of CISH. Measurements and Main Results: The mean operative time of CISH was 135.5 minutes and the mean transverse diameter of uterus was 7.22 cm. The main indications for CISH were uterine myoma or adenomyosis with dysmenorrhea, menorrhagia and vaginal bleeding. The operative time of CISH was affected by the transverse diameter of uterus and operation groups which were categorized in sequence of operation date. Conclusion: Mainly, pre-operative ultrasonographic evaluation of uterine transverse diameter could predict the operative time of CISH.
430 ‘‘The SGRH Technique,’’ a Method Evolved for Safer Total Laparoscopic Hysterectomy Marwah V, Bharadwaj P. Unit of Gynaecology Endoscopic Surgery, Department of Obstetrics & Gynaecology, Sir Ganga Ram Hospital, New Delhi, Delhi, India Study Objective: To evolve a technique for making Total laparoscopic Hysterectomy safer using Marwah’s uterine manipulator and lithotomy poles along with suturing of uterine vessels and vault closure (simulating abdominal hysterectomy for proper vault anchoring) and also keeping the use of thermal energy minimal. Design: Prospective analysis of 1600 cases of total laparoscopic hysterectomy using The Sir Ganga Ram Hospital Technique, for making it safer and better for the patients. Setting: Tertiary care teaching hospital. Patients: 1600 patients referred for Total laparoscopic hysterectomy for indications like Myoma uteri, severe endometriosis etc. Intervention: Total laparoscopic hysterectomy with or without adhesiolysis/ oophorectomy. Measurements and Main Results: Of the 1600 patients who underwent Total laparoscopic Hysterectomy for indications like myoma uteri (40%),Endometriosis (28%), DUB with previous LSCS (14%) and others(18%), the use of this technique reduced the procedure time, decreased complication’s rate and made recovery faster. Conclusion: Total Laparoscopic Hysterectomy using the SGRH technique has become safer and better for the patient and the evolution continues.
431 Big Uterus a Total Laparoscopic Hysterectomy with a Simplyfied Technique Report of 80 Cases Mota M. Endoscopic Gynecologic, Institute National of Perynatology, Mexico, DF, Mexico Study Objective: To Present a technique to made a Total Laparoscopic Hysterectomy in the big utures with a technique simple and safe to prevent morbility and reduce time to the surgery. Design: It Takes in The Institute National of Perynatology in patientes with big uturus size 20 cm and realiza total laparoscopic hysterectomy with the vertical zone technique and the Koh Cup. Setting: TLH and the Koh Cup. Patients: 80 patients with big uterus. Intervention: Total Laparoscopic Hysterectomy. Measurements and Main Results: It was made 80 TLH with mean time of 90 minutes with 80 cc of blood mean, no morbility mean time in hospital 24 hrs no infeccion of cuff.
Conclusion: This techynique is safe and superior to realize TLH in a big uterus.
432 Comparison of the Efficacy of the Pulsed Bipolar System and Conventional Bipolar Electrosurgery in Total Laparoroscopic Hysterectomy (TLH) Park S. Obstetrics and Gynecology, Hallym Medical University, Seoul, Republic of Korea Study Objective: We compared the safety and effectiveness of the pulsed bipolar system (Plasmakinetic; Gyrus Medical, Maple Grove, MN) and conventional electrosurgery (Kleppinger bipolar forceps: Richard Wolf instruments, Vernon Hills, IL) in total laparoscopic hysterectomy. Design: In this retrospective, randomized study, 80 women with benign gynecologic diseases scheduled for TLH were divided into two groups: one group underwent TLH with pulsed bipolar system and the second group underwent TLH with conventional electrosurgery. Outcome measures for both group were compared in terms of length of operation time, amount of blood loss, and the length of hospital stay. Measurements and Main Results: There is no difference in the mean operation time (150 þ 34.7 minutes vs. 159 þ 31.1 minutes, P 5 0.06) between in the pulsed bipolar system group and in the conventional electrosurgery group. The mean blood loss (478.2 þ 200.0 ml vs. 417.5 þ 153.4 ml, P 5 0.13) and the mean length of hospital stay (6.9 þ 1.2 days vs. 6.4 þ 0.5 days, P 5 0.06) were slightly greater in conventional electrosurgery group than those in the pulsed bipolar system group, although these differences were not statistically significant. No patients developed serious complications related either to conventional electrosurgery or to the pulsed bipolar system. Conclusion: Our findings indicate that the pulsed bipolar system is safe and effective as conventional electrosurgery, and in the hands of experienced surgeons, both the pulsed bipolar system and electrosurgery can be used safely in TLH.
433 Clinical Evaluation on 1234 Cases of Pelviscopic Assisted Vaginal Hysterectomy Park HM,1 Kim T,2 Lee ES,1 Rho HK.1 1Obstetrics & Gynecology, Yongsan Hospital College of Medicine Chung-Ang University, Seoul, Republic of Korea; 2Obstetrics & Gynecology, Korea University Ansan Hospital, Ansan, Gyeonggi-Do, Republic of Korea Study Objective: To report our experience with pelviscopic assisted vaginal hysterectomy (PAVH) and evaluate the advantages of PAVH. Design: Retrospective review of records. Setting: Obstetrics & Gynecology unit of Yongsan Hospital College of Medicine Chung-Ang University. Patients: 1234 patients who underwent PAVH from January 1994 to December 2003. Patients checked pap smear before operation. All of patients are benign condition of uterus. Intervention: Pelviscopic assisted vaginal hysterectomy (PAVH). Measurements and Main Results: The mean age was 44.6 6.5 years. The mean parity was 2.3 1.1. Tubal ligation was the most common previous abdominal surgery. Uterine myoma was the most common preoperative surgical indication and post operative diagnosis. The mean operation time was 109.6 42.0 minutes. The mean uterine weight was 209.2 105.5 gm. The mean hemoglobin change was 2.1 1.8 g/dL. The mean hospital stay was 7.5 1.1 days. The complication rate was 3.1%, bladder injury being the most common complication. Conclusion: Hysterectomy can be safely performed vaginally assisted by operative laparoscopy. The further development of laparoscopic instruments and skills will reduce limitations and complication of