Vaginal Hysterectomy: Techniques and Tips Vaginal Hysterectomy: Techniques and Tips Mickey Karram...
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Transcript of Vaginal Hysterectomy: Techniques and Tips Vaginal Hysterectomy: Techniques and Tips Mickey Karram...
Vaginal Hysterectomy: Techniques Vaginal Hysterectomy: Techniques and Tips and Tips
Mickey Karram M.D.Mickey Karram M.D.
Director of UrogynecologyDirector of Urogynecology
The Christ HospitalThe Christ Hospital
Clinical Professor of Ob/Gyn & UrologyClinical Professor of Ob/Gyn & Urology
University of Cincinnati University of Cincinnati
ObjectivesObjectives
Describe the important factors in choosing Describe the important factors in choosing the best route of hysterectomy the best route of hysterectomy
Review some ways to optimize hysterectomy Review some ways to optimize hysterectomy outcomesoutcomes
Discuss and show videos of techniques to Discuss and show videos of techniques to perform vaginal hysterectomy perform vaginal hysterectomy
Vaginal HysterectomyVaginal Hysterectomy
““If you are going to have your tonsils If you are going to have your tonsils
removed, would you prefer they be removed, would you prefer they be
taken out through your throat or taken out through your throat or
through an incision in the side of through an incision in the side of
your neck?”your neck?”
- Chassar Moir- Chassar Moir
Minimize Bleeding During Minimize Bleeding During Vaginal SurgeryVaginal Surgery
Preoperative assessmentPreoperative assessment
Discontinue NSAIDS, ASA 2 weeks pre-opDiscontinue NSAIDS, ASA 2 weeks pre-op
Bleeding diathesisBleeding diathesis
Careful entry into proper tissue planesCareful entry into proper tissue planes
Normal saline injectionNormal saline injection
Lidocaine 1% with epinephrine 1:200,000Lidocaine 1% with epinephrine 1:200,000
PitressinPitressin
Difficult Entry into Posterior Difficult Entry into Posterior Cul-de-Sac can be caused by:Cul-de-Sac can be caused by:
Shallow Pouch of DouglasShallow Pouch of Douglas
Long cervixLong cervix
EndometriosisEndometriosis
Posterior cervical or lower uterine Posterior cervical or lower uterine segment myomassegment myomas
Pelvic adhesionsPelvic adhesions
Difficult Entry into Posterior Difficult Entry into Posterior Cul-de-SacCul-de-Sac
Traction-countertractionTraction-countertraction
Sharp dissectionSharp dissection
Digital rectal examDigital rectal exam
Extraperitoneal pedicle ligationExtraperitoneal pedicle ligation
Palpation of cul-de-sac via anterior colpotomyPalpation of cul-de-sac via anterior colpotomy
Division of posterior cervixDivision of posterior cervix
Difficult Entry into Anterior Difficult Entry into Anterior Cul-de-SacCul-de-Sac
Try to Try to seesee the peritoneum before cutting the peritoneum before cutting
Traction-countertractionTraction-countertraction
Sharp dissectionSharp dissection
Extraperitoneal pedicle ligationExtraperitoneal pedicle ligation
Digital palpation of anterior reflection via the Digital palpation of anterior reflection via the posterior cul-de-sacposterior cul-de-sac
Uterine sound in bladder; retrograde bladder fillUterine sound in bladder; retrograde bladder fill
TractionTraction and and
Counter-traction Counter-traction
help to increase the help to increase the
distance between distance between
the clamps and the the clamps and the
ureter, thus ureter, thus
minimizing the risk minimizing the risk
of ureteral injury of ureteral injury
during vaginal during vaginal
hysterectomyhysterectomy
Clamp and ligate the pedicles in continuity to help avoid bleeding
Route of Hysterectomy Route of Hysterectomy
May the vaginal hysterectomy May the vaginal hysterectomy
never be to gynecology what never be to gynecology what
breech delivery has become to breech delivery has become to
obstetrics.obstetrics.
- George Morley- George Morley