Vag_Hysterectomy.pptVIP

Vaginal Hysterectomy: Modified Safe Technique Professor Galal Lotfi, MD, MRCOG Obstetrics Gynecology Suez Canal University Egypt Suez Canal University Hospital Aim? This is not a comparison between vaginal and abdominal Hyst. This is not a comparison between vaginal and laparoscopic Hyst. Aim Of That Work Reviving, a Well Known Technique for Hysterectomy. Implementing a Technique, Safe Without the Tragic Vault prolapse. Material and Methods Women for hysterectomy. No prolapse. No contraindication for vaginal hyst. Indications Dub 188 Fibroid uterus 79 Adenomyosis 8 CIN 3 Contraception 1 Requirements Mobility; Especially downwards Uterus less than 12 weeks Cervix not atrophied Fornices adequate Healthy tissues Assessment under anesthesia, in lithotomy Broad Lines of the Technique; To be safe: secure pedicles at all times. To avoid a post operative vault prolapse: secure pedicles to vagina. First Clamp First Clamp After pushing up the bladder and opening the pouch of Douglas POD , 1st clamp is applied to uterosacral ligament as close to the uterus as possible; Confirming that the inside blade is inside the peritoneal cavity to include the small vessels between the peritoneum and the base of the pelvis Ligatures. First ligatures is left with long threads, one with needle will be used to have a bite in the lateral vaginal angle so: Support the vaginal vault by ligating it to the main supporting structures of the pelvis Shares in the homeostasis of that vascular area Stitching First Pedicle to Vaginal Angle Occlusion of the space in between Closure of small vessels Fixing uterosacral to vagina 2nd Ligatures, Step ladder Uterine, Ovarian Ligatures So, At the End.. The whole three pedicles are ligated together on one side with marked stitch. During peritonization, one thread from round ligament was tied to its counterpart on the other side and peritoneum was approximated At the end, The pedicles are sutured to the vagina: That vaginal angle was sutured to