TOTAL LAPAROSCOPIC HYSTERECTOMY

usingSINGH

MANIPULATOR, FUNNEL and HANDSFREEPELVIC ASSISTANT (PA)

Instruments used

• Uterine Manipulator• Vaginal Funnel• Uterine Artery Needle Tie• Uterine Hook Dissector• Pelvic Probes• Vaginal Plug

• HANDSFREE (PA) PELVIC ASSISTANT

SET UP

• Place patient in lithotomy.• Make sure the symphysis pubis is over

the end of the operating table, not just the buttocks. This will ensure that maximum anteversion can be achieved when required.

INSERT FOLEY’S CATHETER.

ATTACH VULSELLUM TO CERVIX.

DILATE CERVIX WITH STRAIGHT END OF INNER ROD. DO NOT DILATE ANY MORE THAN DIAMETER OF INNER ROD.

SOUND THE LENGTH OF THE UTERINE CAVITY WITH THE INNER ROD.

INSERT CURVED END OF MANIPULATING ROD INTO CERVIX UP TO UTERINE FUNDUS. USE STRAIGHT ROD FOR LSH, AS ROD CAN BE RETRACTED FROM UTERUS DURING MORSELLATION.

SLIDE UTERINE CANNULA ON MANIPULATING ROD UP TO CERVIX.

HOLD ON TO ROD WITH OTHER HAND TO PREVENT IT FROM BEING PUSHED PAST FUNDUS.

SCREW CANNULA INTO CERVIX UP TO LEVEL OF THE O RING.

IN FIRST FEW CASES, I SUGGEST PLACING A STAY SUTURE (1 NYLON) AT 12 O’CLOCK ON THE ECTOCERVIX AND TIE AROUND THE CANNULA A FEW TIMES. REPEAT AT 3 O’CLOCK IF OS IS PATULOUS OR UTERUS IS VERY LARGE.

THIS WILL ALLOW YOU TO DELIVER THE UTERUS AT THE END OF THE PROCEDURE. OTHERWISE YOU WILL HAVE TO INSERT A VULSELLUM INTO THE VAULT TO GRAB THE CERVIX.

MANIPULATOR SCREWED INTO CERVICAL OS

SLIDE FUNNEL ALONG UTERINE CANNULA.

REMOVE VULSELLUM FROM CERVIX.

PUSH FUNNEL ALONG UTERINE CANNULA INTO VAGINA WITH THE EDGE OF THE FUNNEL PLACED POSTERIORLY.

PUSH FUNNEL FIRMLY INTO THE VAGINA AGAINST THE VAGINAL VAULT.

FUNNEL ON MANIPULATOR

PLACE BLACK OR WHITE HOLDING SCREW BEHIND FUNNEL SHAFT TO PREVENT IT SLIPPING OUT OF THE VAGINA.

YOUR PELVIC ASSISTANT NOW HOLDS THE CANNULA OR YOU CAN ATTACH IT TO THE HANDSFREE PA.

THIS IS THE FINAL SET UP IN THE PATIENT.

ROTATE THE FUNNEL SHAFT TO PRESENT THE EDGE FOR DISSECTION.

PLEASE NOTE NEW SINGLE PIECE FUNNELS HAVE REPLACED SCREW ON MODELS.

THE INNER ROD CAN BE PUSHED, WITHDRAWN OR ROTATED UNDER LAPAROSCOPIC CONTROL TO FURTHER MANIPULATE THE UTERUS.

VAGINAL PLUG TO STOP CO2 LEAK DURING COLPOTOMY. PUSH ONTO FUNNEL WHEN LEAK OCCURS.

PUSH PLUG ONTO FUNNEL TO BLOCK INTROITUS ONLY WHEN LEAK OCCURS