TLH with Safe bladder dissection
Education event Sponsored by: Medtronic
Conference Name: Gynecology Workshop
Conducted by: Medtronic India & Ankur Maternity Home & Clinic
Surgeon(s)/Speaker(s): Dr. Mohil D. Patel
Surgical Procedure: Gynecology-Uterus - TLH
Location: Ankur Maternity Home & Clinic, Ahmedabad
Indexsteps
1. Q and A :
2. Q and A :
3. Q and A :
4. Q and A :
port positions
1. Working With Ports : * Standard 5 ports * 5-10mm Umbilicus * Two 5mm ports on either side of umbilicus at the same level in mid clavicular line/semilunar line
* Two 5mm ports on either side 2cm above and medial to anterior superior iliac spine
precautionary_measures
1. TLH-Precautions : 1.Keep a flat good bipolar forceps ready-capable of putting enough pressure to control uterines. 2.Avoid cutting into uterine wall-leave a small stump on uterine side while dissecting tubes,round ligament & ovarian ligament. 3.Avoid holding bowel wall to empty pouch of Douglas- retract holding appendix epiploicae on sigmoid colon. 4.Avoid cutting UV fold too high - remain in the loose area. 5.Avoid blunt dissection of bladder. 6.Dissect posterior leaf of broad ligament and cut the uterosacral ligaments before taking the uterines. 7.Clamp and seal uterines high and flush on uterus to create long uterine stump. 8.Skeletonize cervix by cutting precervical fascia. 9.Avoid cutting into cervix. 10.Identify vault- avoid dissecting uterine stump too low. 11.Avoid monopolar current at vault angles and posterior wall. 12.Avoid excessive force while delivering uterus per vaginum-cut uterus. 13.Suture uterosacral ligaments to vault. 14.Ensure Mucosa to mucosa approximation of vault- avoid bladder wall. 15.Ensure total homeostasis and flush clean all blood. 16.All 10mm ports -suture close fascia
pre_post_measures
1. Preoperative investigations : Surgical Profile- *U/S abdomen *PAP Smear *Endometrial biopsy
2. Preoperative measures : 2 Days liquid diet:new:2 Nights tab.dulcolax:new:No enema
3. Postoperative measures : Sips of water,avoid dry mouth:new:Early ambulation-avoid urinary catheter
4. Warning signs in the postoperative period : Increasing pain and tenderness abdomen:new:Prolonged ileus
Surgical Instruments
1. Sonicision
2. ValleyLab FT10 Energy Platform
3. LigaSure Blunt tip
4. LigaSure Blunt tip
5. 10mm Trocar
6. Specimen retrieval bag
7. 30 degree 10mm telescope
8. Veress needle
9. Thunderbeat Bipolar
10. Maryland forceps
11. Shalya LX cautery
12. Morcellator
13. Trocar
