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Morcellation Techniques for Fibroid Uterus
Published in Rooma Sinha, Arnold P. Advincula, Kurian Joseph, FIBROID UTERUS Surgical Challenges in Minimal Access Surgery, 2020
Prakash Trivedi, Soumil Trivedi, Anjali Sonawane, Aditi Parikh
With the advancement of laparoscopic surgery, the removal of large fibroids or multiple fibroids-uterus was always an issue. In parous women, colpotomy, which has the disadvantage of loss of pneumoperitoneum, limitation in size of fibroid, and occasionally dyspareunia, was used by few. The other option of widening the port size is nearly a minilaparotomy. These methods did not give all the benefits of laparoscopic minimal access surgery.
SBA Questions
Published in Justin C. Konje, Complete Revision Guide for MRCOG Part 2, 2019
A 29-year-old woman who has had two mid-trimester miscarriages had a transabdominal cerclage with a posterior knot at 11 weeks of gestation. She presents at 19 weeks of gestation with a brownish vaginal loss and disappearance of pregnancy signs of 3 days duration. An ultrasound scan confirms an intrauterine fetal death of 18 weeks of gestation. How best will she be managed?Hysterotomy and leave stitch in-situPosterior colpotomy to remove stitch and offer suction evacuationRemove the stitch by laparotomy and induce deliveryRemove the stitch by posterior colpotomy and induce deliveryRemove the stitch laparoscopically and induce delivery
Robotic surgery
Published in J. Richard Smith, Giuseppe Del Priore, Robert L. Coleman, John M. Monaghan, An Atlas of Gynecologic Oncology, 2018
Rabbie K. Hanna, John F. Boggess
Utilizing the least amount of cautery while performing the colpotomy minimizes the thermal injury to the vaginal cuff and decreases the chance of cuff dehiscence postoperatively. Using a single-blade maneuver during colpotomy will also minimize the thermal injury but increases the possibility of vaginal cuff bleeders that can be controlled with pinpoint cautery or while suturing the cuff.
The Comparison of Surgical Outcomes following Laparoscopic Hysterectomy and vNOTES Hysterectomy in Obese Patients
Published in Journal of Investigative Surgery, 2022
Cihan Kaya, Şükrü Yıldız, İsmail Alay, Özgür Aslan, İlke Esin Aydıner, Levent Yaşar
Patients were placed in the high lithotomy position under general endotracheal anesthesia. The vaginal retractors were used for adequate cervical visualization. The anterior and posterior lips of the cervix grasped with two tenacula. A circumferential cervical incision was performed. Blunt and sharp dissections separated the vaginal mucosa over the cervical fascia. The sacrouterine ligaments were cut and tied as in the conventional VH. Anterior and posterior colpotomy was then performed. A self-constructed glove port with a small size Alexis wound Retractor, or a GelPoint vPath (Applied Medical, Rancho Santo Margarita, CA) was used as the vaginal access platforms. After an adequate CO2 insufflation, the pneumoperitoneum was set at 12 mmHg. A 20° Trendelenburg position was maintained through the endoscopic procedure. A rigid 0° 10-mm telescope, conventional laparoscopic forceps, and 5 mm sealing device were used. The uterine vessels, adnexal pedicles, and infundibulopelvic ligaments were sealed and cut in caudal-to-cranial direction. The uterus was removed through the vaginal route. The vaginal cuff was peritonised and sutured with a Vicryl 1-0 suture (Ethicon, Piscataway, NJ)
Conventional Laparoscopy or Vaginally Assisted Natural Orifice Transluminal Endoscopic Surgery for Adnexal Pathologies: A Paired Sample Cross-Sectional Study
Published in Journal of Investigative Surgery, 2021
Cihan Kaya, Ismail Alay, Huseyin Cengiz, Sema Baghaki, Ozgur Aslan, Murat Ekin, Levent Yaşar
Although to date there is only one ongoing randomized controlled ‘NOTABLE’ study has been announced by Baekelandt et al. [19], up to now, no evidence-based studies have compared the feasibility of the vNOTES procedure to that of the CL technique. Recently, Li et al. [4] reported a matched paired analysis of the CL and vNOTES techniques via a self-constructed glove port for the treatment of adnexal pathologies. Similar to our results, they reported a shorter duration of surgery (39.2 ± 18.5) and hospital stay (1.4 ± 0.5) in the vNOTES group compared to the CL group. The shorter duration of surgery can be explained by easy access to the ovarian mass after posterior colpotomy, removal of the mass from a larger incision compared to CL, and allowing cystic masses to aspirate. Besides, the length of hospital stay may be associated with the absence of an incision in the abdominal region and the earlier mobilization of the patient and less postoperative pain scores.
Abdominal Hysterectomy with a Uterine Manipulator Minimizes Vaginal Shortening: A Randomized Controlled Trial
Published in Journal of Investigative Surgery, 2021
Huseyin Kiyak, Tolga Karacan, Eser Sefik Ozyurek, Lale Susan Turkgeldi, Pinar Kadirogullari, Kerem Doga Seckin
The same procedure was carried out until the level of the uterine arteries. After the uterine arteries were identified, clamped, cut and sutured, the half-valve colpotomizer was pushed toward the vaginal fornices to identify the colpotomy incision site (Figure 1C). If the vaginal fornices were reached directly without intervening cardinal ligament or sacrouterine ligament clamp/cut/suture steps, a circular colpotomy incision was made directly over the colpotomizer using monopolar cautery (Figure 1D, Figure 2B and 2C). The vaginal cuff was closed with running sutures (Figure 2D).