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Laparoscopy
Published in J. Richard Smith, Giuseppe Del Priore, Robert L. Coleman, John M. Monaghan, An Atlas of Gynecologic Oncology, 2018
Farr Nezhat, Carmel Cohen, Nimesh P. Nagarsheth
Ligation of the uterine artery and unroofing the ureter: the uterine artery is electrodesiccated or clipped just medial to its origin, transected, and rotated anterior to the ureter (Figure 26.22). An angled tip clamp or the tip of the suction irrigator probe is used to widen the ureteral canal; an incision is made anteriorly; it is opened completely and the ureter mobilized. The ureter is unroofed from the ureteral canal and the parametrium is freed. Bipolar electrodesiccation, staples, or surgical clips can be used for achieving hemostasis of the hypogastric venous plexus (Figure 26.23). The uterosacral ligaments and the parametrium are stapled or electrodesiccated with a bipolar vessel sealing device and sequentially transected approximately 1.5 to 3 cm lateral to the cervix, based on the type of radical hysterectomy being performed. The dissection is taken to 2 to 3 cm below the cervix (Figure 26.24). Anterior and posterior culdotomy are performed as described above. After removal of the uterus, the vaginal cuff is closed either laparoscopically or vaginally.
Transvaginal Repair of Urogenital Fistula
Published in Linda Cardozo, Staskin David, Textbook of Female Urology and Urogynecology - Two-Volume Set, 2017
Barry G. Hallner, Kristi L. Hebert, J. Christian Winters
vvF mAy be repAired trAnsvAginAlly or trAnsAbdominAlly. FActors such As size, locAtion, And the need for Adjunctive procedures should influence the choice of ApproAch. one of the most importAnt fActors is the individuAl surgeons' experience. trAnsAbdominAl repAir of vvF is discussed in the following chApter. The mAjority of vvF cAn be repAired trAnsvAginAlly [38]. In 1988, Lee et Al. reported thAt 80% of 303 pAtients were repAired trAnsvAginAlly, regArdless of fistulA size, number, or history of previous repAirs [39]. There Are severAl AdvAntAges to the trAnsvAginAl ApproAch when compAred to A trAnsAbdominAl ApproAch such As shorter operAting time, shorter hospitAl stAy, less postoperAtive pAin, And less blood loss [40]. relAtive disAdvAntAges include vAginAl shortening And difficult exposure involving vvF thAt Are high neAr the vAginAl cuff, especiAlly in deep, nArrow vAginAs or in cAses without Any ApicAl prolApse [24].
Endometrial cancer
Published in David M. Luesley, Mark D. Kilby, Obstetrics & Gynaecology, 2016
Mahalakshmi Gurumurthy, Margaret Cruickshank
Most women present with early-stage disease and primary surgery is fundamental to achieving a cure. As laparoscopic surgery has become a common surgical practice, the treatment of choice should be total laparoscopic hysterectomy and bilateral salpingo-oopherectomy (TLH/BSO) if possible. It is not necessary to remove a vaginal cuff or parametrial tissue for early-stage disease [C]. Recurrence at the vaginal vault is related to recognised risk factors and particularly cervical stromal involvement – factors that reflect lymphatic vessel involvement. Endocervical glandular involvement only is now considered as stage I disease. Additional staging for type 2 tumours and high-grade type 1 tumours should be done which includes omental biopsy and peritoneal washings. Para-aortic lymph node dissection for stage I high-grade tumours is still contentious and not practised routinely.
Vaginal length and sexual function after vertical versus horizontal closure of the vaginal cuff after abdominal hysterectomy: a randomised clinical trial
Published in Journal of Obstetrics and Gynaecology, 2022
Omima Tharwat Taha, Noha Al-Okda, Mostafa Ahmed Hamdy
The impact of vaginal length on sexual function was evaluated (Ye et al. 2014). It was found that the vaginal route decreases vaginal length, which may impact female sexual function (Tan et al. 2006). However, the effect of vertical closure or horizontal closure of the vaginal cuff is not widely studied. After the literature review, it was found that the impact of vertical closure of the vaginal cuff remains unclear with the need for further research. Concerning sexual function, patients’ concern about the effect of hysterectomy on their sexuality (Thakar 2015), together with minimal available data, raised the need for further research and prolonged follow- up periods (Pergialiotis et al. 2018). Besides, the clinical significance of vertical closure of the vaginal cuff is limited in addition to its relevance in women undergoing abdominal hysterectomy (Pergialiotis et al. 2018).
Comparison of Surgical Outcomes of Total Laparoscopic Hysterectomy and vNOTES Hysterectomy for Undescended-Enlarged Uteri
Published in Journal of Investigative Surgery, 2022
Cihan Kaya, Şükrü Yıldız, İsmail Alay, Sema Karakaş, Uğur Durmuş, Hakan Güraslan, Murat Ekin
The LH operation was performed when patients were placed in a low lithotomy position under general endotracheal anesthesia and started with the umbilical insertion of a Veress needle (Ethicon Endo-surgery, Inc., USA). Pneumoperitoneum was obtained with an adequate CO2 insufflation. The intraabdominal pressure was set at 12 mmHg. A 10 mm umbilical optic trocar and three lower 5 mm ancillary trocars were inserted into the abdominal cavity. A 10 mm rigid 0° laparoscope was used in all LH cases for optic visualization. A Clermont-Ferrand uterine manipulator (Karl Storz, Tuttlingen, Germany) was used to manipulate the uterus. The uterosacral ligaments and uterine vessels were sealed and cut using a conventional laparoscopic forceps and a 5 mm advanced sealing device. The uterus was removed through the vaginal opening. A cold-knife vaginal morcellation and myoma enucleation without a bag was performed for the uteri larger than the vaginal orifice. The vaginal cuff was sutured via intra-corporeal approach using a 2.0 V-Loc barbed suture (Medtronic, Minneapolis, MN) [12].
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
The surgery was initiated with the umbilical insertion of a Veress needle to reach pneumoperitoneum. A 10-mm intra-umbilical trocar was inserted for optic visualization. Three 5-mm ancillary trocars were used to introduce endoscopic instruments into the abdominal cavity. The intra-abdominal pressure was set at 12 mm Hg using CO2. A 10-mm rigid 0-degree laparoscope (Karl Storz, Tuttlingen, Germany) was used. A Clermont-Ferrand manipulator (Karl Storz, Tuttlingen, Germany) was utilized to manipulate the uterus. The uterine and adnexal pedicles and uterine arteries were sealed and cut cranially to caudally by using a sealing device. The uterus and/or adnexa was removed through the colpotomy opening. The vaginal cuff was sutured through abdominal approach using a 3-0 V-Loc barbed suture (Medtronic, Minneapolis, MN) [14].