Total Laparoscopic Hysterectomy Replacing the Abdominal Hysterectomy
Laparoscopy is regarded as a nominally invasive operation of the natural body openings are not used. Instead, the surgeon uses an instrument called a laparoscope. Also called endoscopic surgery, laparoscopy is considered an endoscopic procedure and is usually performed by the investigation of the abdominal and pelvic cavity.
The most common diseases are diagnosed and treated by laparoscopy are:
Female reproductive system: doctors can investigate problems such as endometriosis, fibroids, pelvic and vaginal prolapse. It can also be used to determine whether there is abnormality in the uterus, fallopian tubes and ovaries. Ectopic pregnancy can be terminated through a laparoscopic procedure. Certain types of hysterectomy may also be carried out using a laparoscopic procedure.
Adhesions: It can be used to verify the presence of scar tissue in the pelvic cavity.
The diseases of the urinary system: Laparoscopy is used for the treatment probe and both malignant and non-malignant conditions of the kidneys, urethral obstruction and incontinence.
Cancer: cancer of the liver and pancreas can be diagnosed by laparoscopy.
Removal of diseased organs: gallbladder stones and the addition can be removed and hernias can be repaired this procedure.
Laparoscopy is performed under local or general anesthesia, depending on the nature of the problem. This is done with the aid of a laparoscope, which is a long, thin instrument with a light source at its end. This article was inserted in the abdominal or pelvic cavity and can illuminate the cavity. It also has a small lens at the end, through which images are produced through a system of lenses in optical fibers to a video monitor, the surgeon and other staff can see in real time. Laparoscope can be moved into the cavity and allows the doctor to see more views of the authority concerned. Instead of making large incisions, surgeons insert a thin, additional instruments of secondary ports and can easily operate on the patient.
Thus, the idea of laparoscopic procedures that reduce blood loss during surgery and post-operative pain. It is becoming more popular among patients scars are smaller and the recovery period is much shorter. However, the disadvantages are accidental damage to surrounding organs, such as the doctor may have difficulty maneuvering instruments; there is a limited vision and lack of tactile perception. In addition, during the cut can become infected, which may require antibiotic therapy.
Cochrane review in 2009 estimated 27 randomized trials to determine the most appropriate type of hysterectomy for benign gynecological conditions controlled. This meta-analysis concluded that there are no differences between vaginal and laparoscopic hysterectomies for the following parameters: a return to normal activity, conversion to laparotomy and length of hospital stay. Morbidity rates comparing these two types of hysterectomies were similar incidence of pelvic hematoma, vaginal infections, urinary tract infections, respiratory infections and venous thromboembolism. Injury to the urethra and bladder are more common with TLH compared TAH; However, TLH tract lesions were similar to those that pass through the vaginal hysterectomy.
This meta-analysis, however, it is enough to detect a clinically significant increase in the incidence of injury to the bladder or urethra TLH increase. Most data on injuries urinary tract derived from non-randomized trials. TLH Other benefits include a reduced risk of wound infection (in the abdominal wall and cut) and blood loss. The incidence of major surgical complications (bleeding, visceral injury, pulmonary embolism, wound breakdown, anesthetic problems, and conversion to laparotomy) occurred with 11% TLH compared to 6% HST. The times were longer for TLH compared lava work, TAH or HST, as did lava and time Tah comparable performance. shorter time operational obtained for the HST.
Most of these studies reflects the early experience with HTL. Terminal laparoscopy study evaluated in two different time periods, which showed a reduced rate of conversion to laparotomy, the incidence of major complications and uptime. Another study evaluated the results of using the number of hysterectomies performed; He said that after 30 procedures, conversion to laparotomy rate decreased from 9.2% to 2.4%. Opening hours decreased with experience, but the rate of serious complications remained stable.
The surgeon should be familiar with it or with the right room, patient positioning and laparoscopic equipment to facilitate the successful operation position. The patient is in the prone position with spinal hand supination returned to safe patient hand. Positioning arm closest to the patient and allows the surgeon assistant appropriate for each side of the head and shoulder surgery patient, optimizing the angle to the pool.
In books or shoulder pads are commonly used to protect the patient to 20-30 ° Trendelenburg necessary during gynecological laparoscopy. The patient is in the dorsal lying position changed during the installation of the uterine manipulator, while the legs are reduced during laparoscopy. Uterine manipulator position requires shellfish mirror or vaginal retractors, holder and cervical dilators. The low degree Trendelenburg useful during this part of the process. After the successful implementation of the guide catheter and bladder, tabs to return to low-lying position for the remainder of the proceedings.
The surgeon and assistant working on a patient's foot, instead of facing each other in the traditional laparotomy. Assistant operates the camera while the surgeon works with laparoscopic instruments in both hands, one that usually serves as a spacer, while others may be bipolar, monopolar harmonic or seal for cutting and coagulating tissue condition. The wizard has a few clips to use, including non-traumatic, Maryland, bowel or pot holders. Depending on the angle of the fabric, the assistant can be most effective working angle. The suction irrigator can also be a valuable addition to the HTL, although some doctors believe that the number of instruments in the field can be difficult and keep the economy moving. Options for removing tissue include durable bags which are wound on or about laparoscopic extension, open abdominal and cinch before extraction through a large area of the port or port arms.
After complete gynecological examination under anesthesia, the first step consists in positioning and draping the patient, as described above properly. The patient is placed in a modified lithotomy position when installing manipulators uterus. Currently, several manipulators sold. The manufacturer's instructions for installation and application must be tested before use. The correct application of the uterine manipulator is key to a successful TLH, and many of these schemers assist to acknowledge of vital anatomical structures.
After setting up the uterine manipulator, the legs are put back in the low-lying position. Belly is prepared and covered. Peri-umbilical incision is used for introducing pneumoperitoneum. Several methods for achieving this first phase of laparoscopy are used, including open Hasson technique or techniques Veress needle. Rarely open technique is associated with a major organ or vascular injury, but care must be taken, regardless of method of entry. Trocars selection, number and location may depend on several factors, including the habits of the patient, surgical history, uterine size or pelvic masses, seeking to set up an oncology scenario, the instruments available and the degree of participation of assistants.
Additional Trocars can be placed on top or on the side of the navel area to facilitate proper use of the instrument, visualization and mobilization of intra-abdominal structures. After one or two Trocars set, adhesions can facilitate secure additional Trocars placement. Careful and attentive during the development and marketing of pneumoperitoneum trocar technique cannot be overstated as injuries associated with this first part of the process account for two vessels, a recognized and organ damage, and most forensic claims with laparoscopic surgery unrecognizable.
Once you get the appropriate access to the abdomen, round ligaments are marked on both sides, trapped and bipolar or monopolar share with firing. This enables further development and cephalic for sick vessels and retroperitoneal space lateral avascular space. Laparoscopy offers an extremely full sight of the retroperitoneal anatomy, within period can be accepted at this point to identify the course of the urethra and the main blood supply to the pool. The course of the urethra just 1 cm outside the uterus in the uterine arteries and the most common place urethral injury laparoscopically.
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