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‘Staring down the mouth of progress’ Total Laparoscopic Hysterectomy with a Transvaginal Tube Tony McCartney & Andreas Obermair The Journal of the American Association of Gynecologic Laparoscopists February 2004, Volume 11, Number 1: 79-82. Laparovaginal hysterectomy: A decade of evolution.

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slide2

Total Laparoscopic Hysterectomy with a Transvaginal Tube

Tony McCartney& Andreas Obermair

The Journal of the American Association of Gynecologic Laparoscopists

February 2004, Volume 11, Number 1: 79-82.

slide3

Laparovaginal hysterectomy: A decade of evolution.

Jennifer R. Cook, Robert T. O'Shea and Elvis I. Seman

Australian and New Zealand Journal of Obstetrics and GynaecologyVolume 44 Issue 2 Pages 111-116, April 2004

slide4

Robert A. Jones (1993):

Laparoscopic hysterectomy: a technique

Australian and New Zealand Journal of Obstetrics and Gynaecology

Volume 33: pages 290-295.

Laparoscopic hysterectomy: a series of 100 cases

Medical Journal of Australia

Volume 159: pages 447-449.

slide5

Total Laparoscopic Hysterectomy with a Transvaginal Tube

Tony McCartney& Andreas Obermair

The Journal of the American Association of Gynecologic Laparoscopists

February 2004, Volume 11, Number 1: 79-82.

“The technique [of Total Laparoscopic Hysterectomy]

has improved by the use of bipolar diathermy

rather than laparoscopic stapling devices”.

slide6

Laparovaginal hysterectomy: A decade of evolution

Jennifer R. Cook, Robert T. O'Shea and Elvis I. Seman

Australian and New Zealand Journal of Obstetrics and GynaecologyVolume 44 Issue 2 Pages 111-116, April 2004

With regard to one of the major aims of

Laparoscopic hysterectomy of

“enhanced ureteric protection:

staples are no longer used to achieve pedicle

haemostasis in the vicinity of the ureter”.

slide8

A Review of Laparoscopic Ureteral Injury in

Pelvic Surgery.

Ostrzenski A, Radolinski B, Ostrzenski KM.

Obstetrical and Gynecological Survey

December 2003, Volume58: pages 794-799.

slide9

Laparovaginal hysterectomy: A decade of evolution.

Jennifer R. Cook, Robert T. O'Shea and Elvis I. Seman

Australian and New Zealand Journal of Obstetrics and GynaecologyVolume 44 Issue 2 Pages 111-116, April 2004

slide14

Incidence and management of gynaecological-related

ureteric injuries.

Aslan P, Andrew Brooks, Drummond M.

Australian and New Zealand Journal of Obstetrics and Gynaecology

April 1999, Volume 39: pages 178-181.

Abdominal hysterectomy

ureteric injury rate of 0.24%

Western Sydney

slide15

Urinary tract injuries after hysterectomy.

Harkki-Siren P, Sjoberg J, Tiitinen A.

Obstetrics and Gynecology

July 1998, Volume 92: pages 113-118.

Abdominal hysterectomy

ureteric injury rate of 0.4%

- Finland

slide16

IN EXPERIENCED HANDS AND WITH THE RIGHT TECHNIQUE

THE URETERIC INJURY RATE IS NO HIGHER FOR

LAPAROSCOPIC HYSTERECTOMY THAN FOR

ABDOMINAL HYSTERECTOMY

slide17

THE SECURING OF UTERINE VESSELS AT LAPAROSCOPIC

HYSTERECTOMY WITH STAPLES IN EXPERIENCED HANDS

MAY WELL OFFER SIMILAR IF NOT LOWER RATES OF

URETERIC INJURY THAN DOES BIPOLAR DIATHERMY

slide18

IN THE EARLY DAYS OF LAPAROSCOPIC HYSTERECTOMY URETERIC INJURYRESULTED MORE FROM

SURGICAL INEXPERIENCE AND TECHNIQUE DEVELOPMENT THAN OF

INSTRUMENT FAILURE

slide19

WITH THE DEVELOPMENT OF APPROPRIATE TECHNIQUES

AND SURGICAL EXPERTISE, THE CUTTER STAPLING DEVICE HAS A VALUABLE PART TO PLAY IN THE

PERFORMANCE OF LAPAROSCOPIC HYSTERECTOMY

slide20

LEFT OVARY

UTERUS: 510g

slide21

Total Laparoscopic Hysterectomy for Very Enlarged Uteri

Arnaud Wattiez, M.D., D. Soriano, M.D., A. Fiaccavento, M.D., et al.

The Journal of the American Association of Gynecologic Laparoscopists

May 2002, Volume 9, Number 2: pp 125-130.

“The main challenge is

securing uterine vessels”.

slide22

Laparoscopically-Assisted Vaginal Hysterectomy for

Fibroid Uteri Weighing at least 500 grammes.

Nesrin Salmanli and Peter Maher

Australian and New Zealand Journal of Obstetrics and Gynaecology

April 1999, Volume 39: pages 182-184.

slide23

Endoscopic Stapling of Large Uterine Vessels at

Laparoscopic Hysterectomy for Uterine Fibroid Masses

Of 500g or more: a pilot study.

Roger McMaster-Fay

Gynecology Surgery

2004, Volume 1: pages 195-197.