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Total Laparoscopic Hysterectomy – How the Singh Uterine Manipulator and Funnel Demystyfies the Procedure
Abstracts / Journal of Minimally Invasive Gynecology 15 (2008) S1eS159 PAVH and PAVH will replace abdominal hysterectomy, completely in the future.
434 Indigo Carmin Test Visualized by Cystoscopy to Identify Ureteral Indemnity during Hysterectomy with McCall Culdoplasty Ricci P, Pardo J, Sola` V. Obstetrics and Gynecology, Clı´nica Las Condes, Santiago, Chile Study Objective: To evaluate the incidence of ureteral obstruction due to vaginal hysterectomy (VH) or laparoscopic attended vaginal hysterectomy (LAVH) with McCall´s culdoplasty. To determine the effectiveness of indigo carmine test observe by routine intraoperative cystoscopy to identify the ureteral indemnity. Design: Prospective study of 100 consecutive patients enrolled to VH or LAVH with McCall culdoplasty between January 2003 and January 2008. Setting: Urogynecology and Vaginal Surgery Unit, Obstetrics and Gynecology Department, Clinica Las Condes, Santiago, Chile. Patients: 100 women (38-75 years old) submitted to an elective hysterectomy forr benign indication and McCall culdoplasty for prevention of prolapse. Intervention: Intraoperative cystoscopy with intravenous indigo carmine was routinely performed. Measurements and Main Results: Absent ureteral blue colorant spill of indigo carmine was detected in two women with ureteral obstruction. Both were relieved with Intraoperative suture removal and the second test demonstrated the ureteral indemnity. Conclusion: The incidence of ureteral obstruction during VH or LAVH with McCall culdoplasty is 2%. The indigo carmine test is a simple, safe and effective method to identify the cases with ureteral obstruction. This test allows for immediate recognition and easier treatment of the ureteral complication. In cases with obstruction the solution is removal the McCall sutures during the Intraoperative time avoiding a possible kidney loss. Routine use of indigo carmine test visualized by Intraoperative cystoscopy should be considered when we perform McCall culdoplasty associated to vaginal or laparoscopic attended vaginal hysterectomy.
S117
Design: 4 Private GYNs using similar equipment and technique to perform Total Laparoscopic Hysterectomy from 2002 to 2007. Setting: Operations were conducted over 4 Perth Private Hospitals. Patients: 1448 patients with benign Uterine diseases. Intervention: All patients had their Total Laparoscopic Hysterectomy operations performed using the Singh Uterine Manipulator and Funnel. Measurements and Main Results: A powerpoint presentation of the Technique and Instrumention. The Uterine Manipulator can be seen to provide good Uterine Anteversion and lateral movement. The Funnel Edge rotating on the Uterine Manipulator will be seen lifting the UV Fold, Uterine Vessels and Posterior Fornix for dissection. The tamponade provided by the rotating Funnel Edge makes the procedure relatively bloodless. Ureteric cannula studies to show ureteric distances from the Funnel Edge during its rotation will also be presented. Conclusion: Total Laparoscopic Hysterectomy as a procedure appears to be demystified when using the Singh Uterine Manipulator and Funnel in Perth, Australia.
436 Minimally Invasive Hysterectomy by Ultrasonic Harmonic Ace Scalpel Sola` V, Pardo J, Ricci P. Obstetrics and Gynecology, Clı´nica Las Condes, Santiago, Chile Study Objective: To evaluate the security, effectiveness and advantages of the laparoscopic hysterectomy by ultrasonic scalpel. Design: Prospective study of 50 patients underwent laparoscopic hysterectomy with ultrasonic scalpel, between March 2007 and March 2008. Setting: Gynecology Unit, Obstetrics and Gynecology Department, Clinica Las Condes, Santiago, Chile. Patients: 50 women (38-66 years old, median age 47, median parity 2, BMI 28) submitted to laparoscopic hysterectomy for symptomatic adenomyosis or leiomyomas. Intervention: Total laparoscopic hysterectomies (TLH), laparoscopic supracervical hysterectomies (LSH) and total laparoscopic hysterectomies finished by vaginal route (TLHFV) were made with Harmonic Ace scalpel. Measurements and Main Results: The surgeries were: 15 TLH, 28 LSH and 7 TLHFV. The surgical time was between 45 and 90 minutes for TLH (median 65 minutes), between 23 and 180 minutes (median 45 minutes) for LSH, between 60 and 90 minutes (median 75 minutes) for TLHFV. Complications were not registered during the intraoperative, immediate, early or late postoperative time. Conversion from the laparoscopic to abdominal route was not registered. The visual analogue scale for pain at 12 hours was between 2 and 5 for TLH, between 0 and 2 for LSH, 2 and 5 for TLHFV; at 24 hours between 1 and 4 for TLH, 0 and 2 for LSH, 2 and 4 for TLHFV. The feeding was reinitiated between 8 and 12 hours. The discharge was between 12 to 24 hours. Conclusion: The laparoscopic hysterectomy with ultrasonic scalpel is a safe and effective surgery. This surgery technique allows to cut and to coagulate with comparative advantages on electrosurgery. It allows reducing the damage of near tissues and organs. The ultrasonic scalpel has the potential to become one of the energies preferred for the laparoscopies surgeries.
437 435 Total Laparoscopic Hysterectomy e How the Singh Uterine Manipulator and Funnel Demystyfies the Procedure Singh SJ. GYN, Woodvale Private Hospital, Woodvale, W. Australia, Australia Study Objective: The Singh Uterine Manipulator and Funnel is used to perform 1448 cases of Total Laparoscopic Hysterectomy from 2002 to 2007 by 4 GYNs. This presentation shows the equipment at work and the steps of the procedure.
The Results of Total Laparoscopic Hysterectomy According to BMI Song E, Park J, Hwang S, Im M, Lee B, Lee W. Obstetrics and Gynecology, Inha University Hospital, Incheon, S. Korea, Republic of Korea Study Objective: These days, obesity is a hot issue for gynecologic operation. We reviewed our data of total laparoscopic hysterectomy (TLH) performed by one surgeon retrospectively according to BMI. Design: From March 2003 to Feb 2007, TLH were performed for myoma orCIN3 at our institute. Clinical date including BMI, uterine weight, operation time, blood loss, hemoglobin change after operation, and
434 Indigo Carmin Test Visualized by Cystoscopy to Identify Ureteral Indemnity during Hysterectomy with McCall Culdoplasty Ricci P, Pardo J, Sola` V. Obstetrics and Gynecology, Clı´nica Las Condes, Santiago, Chile Study Objective: To evaluate the incidence of ureteral obstruction due to vaginal hysterectomy (VH) or laparoscopic attended vaginal hysterectomy (LAVH) with McCall´s culdoplasty. To determine the effectiveness of indigo carmine test observe by routine intraoperative cystoscopy to identify the ureteral indemnity. Design: Prospective study of 100 consecutive patients enrolled to VH or LAVH with McCall culdoplasty between January 2003 and January 2008. Setting: Urogynecology and Vaginal Surgery Unit, Obstetrics and Gynecology Department, Clinica Las Condes, Santiago, Chile. Patients: 100 women (38-75 years old) submitted to an elective hysterectomy forr benign indication and McCall culdoplasty for prevention of prolapse. Intervention: Intraoperative cystoscopy with intravenous indigo carmine was routinely performed. Measurements and Main Results: Absent ureteral blue colorant spill of indigo carmine was detected in two women with ureteral obstruction. Both were relieved with Intraoperative suture removal and the second test demonstrated the ureteral indemnity. Conclusion: The incidence of ureteral obstruction during VH or LAVH with McCall culdoplasty is 2%. The indigo carmine test is a simple, safe and effective method to identify the cases with ureteral obstruction. This test allows for immediate recognition and easier treatment of the ureteral complication. In cases with obstruction the solution is removal the McCall sutures during the Intraoperative time avoiding a possible kidney loss. Routine use of indigo carmine test visualized by Intraoperative cystoscopy should be considered when we perform McCall culdoplasty associated to vaginal or laparoscopic attended vaginal hysterectomy.
S117
Design: 4 Private GYNs using similar equipment and technique to perform Total Laparoscopic Hysterectomy from 2002 to 2007. Setting: Operations were conducted over 4 Perth Private Hospitals. Patients: 1448 patients with benign Uterine diseases. Intervention: All patients had their Total Laparoscopic Hysterectomy operations performed using the Singh Uterine Manipulator and Funnel. Measurements and Main Results: A powerpoint presentation of the Technique and Instrumention. The Uterine Manipulator can be seen to provide good Uterine Anteversion and lateral movement. The Funnel Edge rotating on the Uterine Manipulator will be seen lifting the UV Fold, Uterine Vessels and Posterior Fornix for dissection. The tamponade provided by the rotating Funnel Edge makes the procedure relatively bloodless. Ureteric cannula studies to show ureteric distances from the Funnel Edge during its rotation will also be presented. Conclusion: Total Laparoscopic Hysterectomy as a procedure appears to be demystified when using the Singh Uterine Manipulator and Funnel in Perth, Australia.
436 Minimally Invasive Hysterectomy by Ultrasonic Harmonic Ace Scalpel Sola` V, Pardo J, Ricci P. Obstetrics and Gynecology, Clı´nica Las Condes, Santiago, Chile Study Objective: To evaluate the security, effectiveness and advantages of the laparoscopic hysterectomy by ultrasonic scalpel. Design: Prospective study of 50 patients underwent laparoscopic hysterectomy with ultrasonic scalpel, between March 2007 and March 2008. Setting: Gynecology Unit, Obstetrics and Gynecology Department, Clinica Las Condes, Santiago, Chile. Patients: 50 women (38-66 years old, median age 47, median parity 2, BMI 28) submitted to laparoscopic hysterectomy for symptomatic adenomyosis or leiomyomas. Intervention: Total laparoscopic hysterectomies (TLH), laparoscopic supracervical hysterectomies (LSH) and total laparoscopic hysterectomies finished by vaginal route (TLHFV) were made with Harmonic Ace scalpel. Measurements and Main Results: The surgeries were: 15 TLH, 28 LSH and 7 TLHFV. The surgical time was between 45 and 90 minutes for TLH (median 65 minutes), between 23 and 180 minutes (median 45 minutes) for LSH, between 60 and 90 minutes (median 75 minutes) for TLHFV. Complications were not registered during the intraoperative, immediate, early or late postoperative time. Conversion from the laparoscopic to abdominal route was not registered. The visual analogue scale for pain at 12 hours was between 2 and 5 for TLH, between 0 and 2 for LSH, 2 and 5 for TLHFV; at 24 hours between 1 and 4 for TLH, 0 and 2 for LSH, 2 and 4 for TLHFV. The feeding was reinitiated between 8 and 12 hours. The discharge was between 12 to 24 hours. Conclusion: The laparoscopic hysterectomy with ultrasonic scalpel is a safe and effective surgery. This surgery technique allows to cut and to coagulate with comparative advantages on electrosurgery. It allows reducing the damage of near tissues and organs. The ultrasonic scalpel has the potential to become one of the energies preferred for the laparoscopies surgeries.
437 435 Total Laparoscopic Hysterectomy e How the Singh Uterine Manipulator and Funnel Demystyfies the Procedure Singh SJ. GYN, Woodvale Private Hospital, Woodvale, W. Australia, Australia Study Objective: The Singh Uterine Manipulator and Funnel is used to perform 1448 cases of Total Laparoscopic Hysterectomy from 2002 to 2007 by 4 GYNs. This presentation shows the equipment at work and the steps of the procedure.
The Results of Total Laparoscopic Hysterectomy According to BMI Song E, Park J, Hwang S, Im M, Lee B, Lee W. Obstetrics and Gynecology, Inha University Hospital, Incheon, S. Korea, Republic of Korea Study Objective: These days, obesity is a hot issue for gynecologic operation. We reviewed our data of total laparoscopic hysterectomy (TLH) performed by one surgeon retrospectively according to BMI. Design: From March 2003 to Feb 2007, TLH were performed for myoma orCIN3 at our institute. Clinical date including BMI, uterine weight, operation time, blood loss, hemoglobin change after operation, and