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V41 Total laparoscopic hysterectomy technique, tools and video presentation
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Video presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S397–S412
vaginal hysterectomy as compared to abdominal hysterectomy. There was a quicker return to normal activities post operatively and hospital stay was significantly less with patients undergoing vaginal hysterectomy. Conclusion: Vaginal hysterectomy is a minimally invasive and cost effective surgical treatment for women with nondescent bulky uteri due to fibroids or adenomyosis. This route of surgery must be offered to women when a hysterectomy is needed for the above conditions as there is a reduced postoperative morbidity, hospital stay, earlier resumption of normal activities and has an advantage of having no scars on the abdomen. Mastery of this surgery will be important. Results: of non-descent bulky uteri as compared to abdominal hysterectomy. V40 Lumbosacral spondylodiscitis as a complication of LS Sacrocolpopexia A. Popov, T. Manannikova, M. Ramazanov, O. Machanskite, A. Fedorov, K. Abramyan, Y. Zemskov, M. Chechneva Patient K., 31 years old was operated in our clinic. She has Pelvic Organ Prolapse Stage: II “C” (POP-Q). She has 2 pregnancies with 1 vaginal delivery. At March 2008 operation was done: cervix amputation, posterior colporraphya, LS mesh sacrocolpopexia, Burch procedure, paravaginal defect repair. At 21 day after surgery patient admire: extensive pain with irradiation to dorsal parts of the legs, walking difficulties, hyperthermia. Antibacterial, antiinflammatory, symptomatic therapy was started. On the tomographic image Lumbosacral spondylodiscisis L5-S1 was detected. At 65 days after operation we had to remove MESH from the promontorium. Neurosurgical – operative treatment (discectomy, osteosynthesis?) was recognized to be unreasonable. Therapeutist, conservative treatment for 9 months was realized. After 7 months after surgery patient become more active, without extensive pain demanded analgetics. V41 Total laparoscopic hysterectomy technique, tools and video presentation M. Quayyum, M. Farhat. Feni pvt. Hospital Bangladesh Objectives: We discuss the laparoscopic tools used to perform total laparoscopic hysterectomy with a special but very simple device to cut the vaginal vault. We conclude these objectives in an demonstrative video presentation. Material and Methods: From January 2006 to December 2008 we have performed nearly 505 TLH for different uterine pathology. All the patients in whom hysterectomy was chosen as the modality of treatment were included. Patients with uterocervical descent and those are medically unfit for anesthesia and containdication for hysterectomy were excluded. A zero degree 10 mm telescope was used in the optical port at the umbilicus and three standardized lower lateral ports for accesory. Placement of the optical and lower lateral ports were decided on the basis of the uterine pathology, previous surgery. Steps were standardized to achieve uniform procedure with in optimum time. All the Patients were operated under general anesthesia and discharged after 24–48 hours. Results: Our comment of the following: 1. Though costly sealing techniques for tissue / vessels hemostasis, we only used kleppinger bipolar forceps at 35 watts; 2. The use of a simple device with Purandare uterine manipulator during cervical traction to cut the vaginal vault; 3. None of our patients had visceral or vascular injury or immediate post-operative bleeding; 4. Gas leakage was very minimum and operation was complete within 30–90 minutes;
5. Only one intraoperative bladder injury which managed by intracoporal suturing and only two ureteric thermal injury manifested as uteric fistula after 7 days. Conclusions: Total laparoscopic hysterectomy can be carried out successfully by very simple equipments. V42 Meconium-stained amniotic fluid as an independent risk factor for fever and postpartum infection in term pregnancy F. Rahimi-Sharbaf, F. Davary-Tanha. Tehran University of Medical Science Background: The aim of this study was to statistically evaluate the hypothesis that the presence of meconium-stained amniotic fluid is associated with postpartum maternal infection. Methods: This prospective cohort study included 573 term pregnant women in labor, with no other medical problems, that underwent cesarean section for pregnancy termination. Women with prolonged active-phase labor, prolonged rupture of membranes, complicated cesarean section and pre-operative infections were excluded from this study.The subjects were divided into two groups: 280 women with meconium-stained amniotic fluid (M group), and 293 women with clear amniotic fluid (C group). A comparison was done regarding postpartum fever, endometritis and wound infection between the two groups. Student’s t-test and chi square test were used for data analysis, along with linear regression, with p < 0.05 indicating significance. Results: Among the 573 women, a total of 82 women (14%) had fever after cesarean; 42 women from the M group, and 40 women from the C group (p = 0.3). Among the 82 women who had fever, 33 women had continuous fever, 6.5% in group M and 2.7% in group C (p < 0.05, RR: 1.98, 95% CI 1.3–3.1). Among the 573 women, 4% veloped endometritis 5% in group M and 2% in group C (p < 0.05, RR: 2.3, 95% CI 1.3–3.4). Similarly, among the 573 women, a total of 5 women (1%) developed wound infection, 1.7% in group M and 0.68% in group C (p = 0.7). Conclusion: Meconium-stained amniotic fluid is associated with increased postpartum infection independent of other risk factors for infection. V43 Triple tie technique – A simple life saving procedure in Atonic PPH Samartha Ram, Shankar Ram Procedure: Three Disposable Foley’s catheters were used as tourniquet.Two rents were made in the avascular areas of the broad ligament on either side of the uterus at the level of lower segment. The catheter was tied around the lower segment like a tourniquet by passing it through the rents. Two other ties were applied one on either side by passing through the same rent and applying around the ovarian pedicle medially securing perfect hemostasis & avoiding ischemia to ovaries. This simple minimum interference technique is instantaneous, effective and a preliminary measure with minimal expertise can be performed even at primary health care centers.This procedure considerably buys the golden hour preventing hemorrhagic shock and enable safe transportation to higher centers. V44 Laparo-endoscopic single site (LESS) simple hysterectomy J. Rivero, R. Sotelo, J. Rivero Stoessel, C. Oswaldo, A. Monish Purpose: To present the first clinical report and detailed technique LESS simple hysterectomy. Patients and Methods: We performed LESS simple hysterectomy in five cases at our institutions for various indications of abdominal hysterectomy. These included recurrent high grade cervical intra-epithelial neoplasia after loop electrical excision
Video presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S397–S412
vaginal hysterectomy as compared to abdominal hysterectomy. There was a quicker return to normal activities post operatively and hospital stay was significantly less with patients undergoing vaginal hysterectomy. Conclusion: Vaginal hysterectomy is a minimally invasive and cost effective surgical treatment for women with nondescent bulky uteri due to fibroids or adenomyosis. This route of surgery must be offered to women when a hysterectomy is needed for the above conditions as there is a reduced postoperative morbidity, hospital stay, earlier resumption of normal activities and has an advantage of having no scars on the abdomen. Mastery of this surgery will be important. Results: of non-descent bulky uteri as compared to abdominal hysterectomy. V40 Lumbosacral spondylodiscitis as a complication of LS Sacrocolpopexia A. Popov, T. Manannikova, M. Ramazanov, O. Machanskite, A. Fedorov, K. Abramyan, Y. Zemskov, M. Chechneva Patient K., 31 years old was operated in our clinic. She has Pelvic Organ Prolapse Stage: II “C” (POP-Q). She has 2 pregnancies with 1 vaginal delivery. At March 2008 operation was done: cervix amputation, posterior colporraphya, LS mesh sacrocolpopexia, Burch procedure, paravaginal defect repair. At 21 day after surgery patient admire: extensive pain with irradiation to dorsal parts of the legs, walking difficulties, hyperthermia. Antibacterial, antiinflammatory, symptomatic therapy was started. On the tomographic image Lumbosacral spondylodiscisis L5-S1 was detected. At 65 days after operation we had to remove MESH from the promontorium. Neurosurgical – operative treatment (discectomy, osteosynthesis?) was recognized to be unreasonable. Therapeutist, conservative treatment for 9 months was realized. After 7 months after surgery patient become more active, without extensive pain demanded analgetics. V41 Total laparoscopic hysterectomy technique, tools and video presentation M. Quayyum, M. Farhat. Feni pvt. Hospital Bangladesh Objectives: We discuss the laparoscopic tools used to perform total laparoscopic hysterectomy with a special but very simple device to cut the vaginal vault. We conclude these objectives in an demonstrative video presentation. Material and Methods: From January 2006 to December 2008 we have performed nearly 505 TLH for different uterine pathology. All the patients in whom hysterectomy was chosen as the modality of treatment were included. Patients with uterocervical descent and those are medically unfit for anesthesia and containdication for hysterectomy were excluded. A zero degree 10 mm telescope was used in the optical port at the umbilicus and three standardized lower lateral ports for accesory. Placement of the optical and lower lateral ports were decided on the basis of the uterine pathology, previous surgery. Steps were standardized to achieve uniform procedure with in optimum time. All the Patients were operated under general anesthesia and discharged after 24–48 hours. Results: Our comment of the following: 1. Though costly sealing techniques for tissue / vessels hemostasis, we only used kleppinger bipolar forceps at 35 watts; 2. The use of a simple device with Purandare uterine manipulator during cervical traction to cut the vaginal vault; 3. None of our patients had visceral or vascular injury or immediate post-operative bleeding; 4. Gas leakage was very minimum and operation was complete within 30–90 minutes;
5. Only one intraoperative bladder injury which managed by intracoporal suturing and only two ureteric thermal injury manifested as uteric fistula after 7 days. Conclusions: Total laparoscopic hysterectomy can be carried out successfully by very simple equipments. V42 Meconium-stained amniotic fluid as an independent risk factor for fever and postpartum infection in term pregnancy F. Rahimi-Sharbaf, F. Davary-Tanha. Tehran University of Medical Science Background: The aim of this study was to statistically evaluate the hypothesis that the presence of meconium-stained amniotic fluid is associated with postpartum maternal infection. Methods: This prospective cohort study included 573 term pregnant women in labor, with no other medical problems, that underwent cesarean section for pregnancy termination. Women with prolonged active-phase labor, prolonged rupture of membranes, complicated cesarean section and pre-operative infections were excluded from this study.The subjects were divided into two groups: 280 women with meconium-stained amniotic fluid (M group), and 293 women with clear amniotic fluid (C group). A comparison was done regarding postpartum fever, endometritis and wound infection between the two groups. Student’s t-test and chi square test were used for data analysis, along with linear regression, with p < 0.05 indicating significance. Results: Among the 573 women, a total of 82 women (14%) had fever after cesarean; 42 women from the M group, and 40 women from the C group (p = 0.3). Among the 82 women who had fever, 33 women had continuous fever, 6.5% in group M and 2.7% in group C (p < 0.05, RR: 1.98, 95% CI 1.3–3.1). Among the 573 women, 4% veloped endometritis 5% in group M and 2% in group C (p < 0.05, RR: 2.3, 95% CI 1.3–3.4). Similarly, among the 573 women, a total of 5 women (1%) developed wound infection, 1.7% in group M and 0.68% in group C (p = 0.7). Conclusion: Meconium-stained amniotic fluid is associated with increased postpartum infection independent of other risk factors for infection. V43 Triple tie technique – A simple life saving procedure in Atonic PPH Samartha Ram, Shankar Ram Procedure: Three Disposable Foley’s catheters were used as tourniquet.Two rents were made in the avascular areas of the broad ligament on either side of the uterus at the level of lower segment. The catheter was tied around the lower segment like a tourniquet by passing it through the rents. Two other ties were applied one on either side by passing through the same rent and applying around the ovarian pedicle medially securing perfect hemostasis & avoiding ischemia to ovaries. This simple minimum interference technique is instantaneous, effective and a preliminary measure with minimal expertise can be performed even at primary health care centers.This procedure considerably buys the golden hour preventing hemorrhagic shock and enable safe transportation to higher centers. V44 Laparo-endoscopic single site (LESS) simple hysterectomy J. Rivero, R. Sotelo, J. Rivero Stoessel, C. Oswaldo, A. Monish Purpose: To present the first clinical report and detailed technique LESS simple hysterectomy. Patients and Methods: We performed LESS simple hysterectomy in five cases at our institutions for various indications of abdominal hysterectomy. These included recurrent high grade cervical intra-epithelial neoplasia after loop electrical excision