A laparoscopic bipolar cutting forceps can assist in a case of difficult vaginal hysterectomy
ABSTRACT A vaginal approach to hysterectomy can become challenging when visualization is limited by poor or absent uterine descent, obesity, or other factors that make an approach to the uterine pedicles difficult. When factors occur that make application or visualization of conventional vaginal instruments difficult, using an instrument designed for laparoscopic application, with its thin, elongated shape, may permit continuation of a vaginal approach. In such a case, a Gyrus bipolar laparoscopic cutting forceps was used for coagulation and transection of the uterine pedicles during a vaginal hysterectomy. This represents a way to expand on traditional techniques for completion of difficult vaginal hysterectomy, which may be used concurrently. Surgical techniques that more easily and safely permit completion of hysterectomy by the vaginal approach can improve outcomes for all.
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ABSTRACT: Unter dem Aspekt der Prvalenz der weiblichen Adipositas von 15–25% in den Industrienationen stellt die elektive, die onkologische, aber besonders auch die notfallmige operative Versorgung extrem bergewichtiger Patientinnen spezielle Anforderungen an Ausstattung, Logistik und Kompetenz von Kliniken und rzten. Das typische Spektrum gynkologischer Operationen bei Fettleibigkeit reicht von Routineeingriffen zur Behebung von Deszensus und Harninkontinenz ber groe onkologische Beckenchirurgie bis zu plastisch-sthetischen bzw. medizinisch indizierten Reduktionsplastiken. Grundstzlich profitieren adipse Patientinnen aufgrund der deutlich geringeren Wundheilungsproblematik von den Mglichkeiten der minimal-invasiven Chirurgie. Zur Vermeidung intra-, peri- und postoperativer Komplikationen sind sowohl die apparativen Ausstattungen (z.B. entsprechend tragfhige Operationstische) als auch adipositasbedingte diagnostische und operative Besonderheiten zu beachten; ggf. sind spezialisierte operative Zentren auszuwhlen.The prevalence of female obesity is 15–25% in western countries and requires a high level of specialization in technical and professional competence of hospitals and the operating teams treating these patients. Typical procedures in gynecological surgery of morbidly obese women range from correction of descensus uteri and incontinence to oncological pelvic surgery and specifically indicated operations such as mammoplasty and abdominoplasty. Due to significantly reduced wound healing problems obese patients will benefit most from minimally invasive surgery. To avoid operative complications technical aspects like sustainable operating tables as well as diagnostic and surgical specialties have to be considered and it seems advisable to establish specialized centers for treatment.Der Gynäkologe 01/2006; 39(12):963-969. DOI:10.1007/s00129-006-1907-1
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ABSTRACT: This study was undertaken to compare the use of bipolar vessel sealing system (BVSS) with conventional suture ligature in vaginal hysterectomy (VH) on a non-prolapsed uterus. Women referred for VH for uterine myoma were randomized to BVSS (n=45) or conventional suture ligature VH (n=45). Exclusion criteria were uterine prolapse and indication associated surgical procedures. Main outcome measures were operative time, blood loss, hospital stay, pain status, peri and post-operative complications. Data of patients were collected prospectively. Statistical analysis was performed using chi-square and Student's t-test as appropriate. There were no differences in patients' mean age, parity and uterine size between groups. Patients in the BVSS group had a significantly reduced operating time (29.2+/-2.1 min vs. 75.2+/-5 min; p<0.001), operative blood loss (84+/-5.9 mL vs. 136.4+/-89.1 mL; p=0.001), requirement of surgical sutures (1.2+/-0.6 units vs. 7.4+/-0.3 units; p<0.001), pain status (1.6+/-0.4 vs. 3.6+/-0.4; p<0.001) and hospital stay (25.6+/-0.9h vs. 33.2+/-1.7h; p<0.001) compared to the control group. The overall complication rate in the study was 7.8% (7/90), and did not differ between patients of the BVSS and control group. Bipolar vessel sealing for vaginal hysterectomy appears to be an effective and safe haemostatic control method, with reduced operating time, peri-operative blood losses, post-operative pain and hospital stay.European journal of obstetrics, gynecology, and reproductive biology 05/2009; 146(2):200-3. DOI:10.1016/j.ejogrb.2009.03.014 · 1.63 Impact Factor
Article: Difficult vaginal hysterectomy[Show abstract] [Hide abstract]
ABSTRACT: A difficult vaginal hysterectomy can challenge the most accomplished pelvic surgeon. Large uterine size or prior pelvic surgery is commonly thought to make a vaginal hysterectomy more difficult, but more common issues such as large body habitus or extensive prolapse may make performing a vaginal hysterectomy even more technically challenging. The knowledge and expertise needed to perform a routine vaginal hysterectomy are prerequisites for managing more difficult cases. As techniques in pelvic surgery continue to evolve, it is critical that this minimally invasive procedure continue to be taught and performed.Clinical obstetrics and gynecology 03/2010; 53(1):40-50. DOI:10.1097/GRF.0b013e3181ce8945 · 1.53 Impact Factor