Laparoscopic Hysterectomy

Conversion Risks into Laparotomy, Intra and Post-surgical complications

Coordinators : Lect. M.D. PhD Nicolau C-tin. Romeo Dr. Costea N. Monica

Author : Marin Argyriou DimitrisCoAuthors : Spirchez Ralisa, Rijnoveanu Iulia, Roxana Mihalcut

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Introduction

Laparoscopy is a procedure that allows us to study the Laparoscopy is a procedure that allows us to study the abdominal cavity using a cold light sourceabdominal cavity using a cold light source

Laparoscopic surgery is a procedure which allows us to Laparoscopic surgery is a procedure which allows us to study outside of the abdomen but also allows us the use of study outside of the abdomen but also allows us the use of the microscopical instruments in abdominal cavity.the microscopical instruments in abdominal cavity.

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Information Kurt Semm in 1984 in Germany described for the first time Kurt Semm in 1984 in Germany described for the first time

a technique for laparoscopic assistance in vaginal a technique for laparoscopic assistance in vaginal hysterectomy.The annexes were separated laparoscopically in hysterectomy.The annexes were separated laparoscopically in order to simplify the vaginal hysterectomyorder to simplify the vaginal hysterectomy. .

Laparoscopically Assisted Vaginal Laparoscopically Assisted Vaginal HysterectomyHysterectomy

The First Laparoscopic Hysterectomy was The First Laparoscopic Hysterectomy was effectuated in Pennsylvania in 1988 by effectuated in Pennsylvania in 1988 by M.D. Harry Reich.M.D. Harry Reich.

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M.D. Harry ReichM.D. Harry Reich Prof. Kurt SemmProf. Kurt Semm

LAPAROSCOPIC LAPAROSCOPIC HYSTERECTOMYHYSTERECTOMY

CLASSICAL CLASSICAL HYSTERECTOMYHYSTERECTOMY

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ProcedureProcedureThe Proceduce consist in 5 steps. After the General The Proceduce consist in 5 steps. After the General

Anesthesia is done:Anesthesia is done:

1) CO2 will be intraabdominal injected, using the Veress 1) CO2 will be intraabdominal injected, using the Veress needleneedle

2) The telescop will be inserted through the Umbilicus 2) The telescop will be inserted through the Umbilicus

3) The other instruments are going to be introduced 3) The other instruments are going to be introduced through another 3 incisions about through another 3 incisions about 1cm1cm diameter each diameter each

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ProcedureProcedure

4) The Uterus will be separated and afterwards it will be fragmented by the Morcellator, or it can be extracted through vaginal way

5) Usually a drainage tube is being left in the Douglas sack in order to detect an eventual complication, such as a possible hemorrhage.

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Morcellator

Other InstrumentsOther Instruments

Uterine-Manipulator Clermont Ferrand

Laparocopic Ports-Scissors-Forceps- Camera Etc.

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Objective & PurposeObjective & Purpose

The purpose of my paper is to show the efficiency of The purpose of my paper is to show the efficiency of the laparoscopic procedure and the experience that the laparoscopic procedure and the experience that more and more doctors are acquiring with the evolution more and more doctors are acquiring with the evolution of technology. of technology.

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Material MethodMaterial Method

Our study has been done on 74 women, Our study has been done on 74 women, aged 31- 83 years old from Obstetrics-Gynecology aged 31- 83 years old from Obstetrics-Gynecology Clinic No I from Tg.Mures. Clinic No I from Tg.Mures.

2006 – 20142006 – 2014

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IndicationsIndicationsThe The Laparoscopical HysterecomyLaparoscopical Hysterecomy in our study in our study has been has been

applied in the following cases :applied in the following cases : Endometriosis – Endometriosis – FibromsFibroms

H-SiL & H-SiL & CIN Stg 2-3CIN Stg 2-3

Endometrial Tissular Overgrowth (Hyperplasia)Endometrial Tissular Overgrowth (Hyperplasia)

Uterin Cancer & Adenocarcinoma Std IAUterin Cancer & Adenocarcinoma Std IA

Infections and Cysts upon Ovarian tubesInfections and Cysts upon Ovarian tubes

Several Vaginal ProlapseSeveral Vaginal Prolapse

Hemorrhagic MetropatiaHemorrhagic Metropatia

Cystorectocel with urinary retentionCystorectocel with urinary retention

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Results

LAVH CONVERTED HyLT0

5

10

15

20

25

30

35

40

Laparoscopic Hysterectomy

2006-2014

LAVH

CONVERTED

HyLT

16 = 21,6% 18 = 24,4 % 40 = 54%

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Intraoperative RisksIntraoperative Risks

It can be many such as :It can be many such as : Damage of the BladderDamage of the Bladder, Ureters, Bowel and Annexes , Ureters, Bowel and Annexes

Vessel Damage (Aorta, Inf Vena cava, Uterine artery)Vessel Damage (Aorta, Inf Vena cava, Uterine artery)

Bladder continuity solutionBladder continuity solution

Cardiac Arrhythmia due to AnesthesiaCardiac Arrhythmia due to Anesthesia

Subcutaneous Emphysema Subcutaneous Emphysema

Gas Embolism Gas Embolism

HypercapniaHypercapnia

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ResultsResults

CONVERTED HYSTERECTOMY0

1

2

3

4

5

6

7

8

9

10 Reasons of Convertions

2006 - 2014

Difficult Adhesiolysis

Posterior Nodules

Intraligamentar Devel-opment of fibrom

Technical Difficulties

Bladder Continuity solu-tion

Suspicion of Malignancy

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Results

* 38 cases required Bilateral Annexectomy.

* 19 cases required anterior Colporrhaphy, and 17of them necessitated Colpoperineoplasties.

* To 43 patients, a drainage tube was introduced in Douglas Sack for a better efficient control of the Hemostastys.

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Postoperative risksPostoperative risksIt didn't exist any early postoperatory complications It didn't exist any early postoperatory complications

in our study but also it could bein our study but also it could be : :

Blood clot in the Legs or Lungs ( Trombosis, Pulmonary embolia) Blood clot in the Legs or Lungs ( Trombosis, Pulmonary embolia)

Vaginal Prolaps Vaginal Prolaps

Infection, Inflamatio Infection, Inflamatio

Incisions Opens Incisions Opens

Vulvar Edema Vulvar Edema

Nerve Injury due to AnesthesiaNerve Injury due to Anesthesia

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ResultsResults

The main time of Hospitalisation was 3-4 days The main time of Hospitalisation was 3-4 days for Laparoscopical interventions and 5-7 days for the ones for Laparoscopical interventions and 5-7 days for the ones

Converted into LaparotomyConverted into Laparotomy

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ConclusionsConclusions

The Laparoscopic Assisted Vaginal Hysterectomy is The Laparoscopic Assisted Vaginal Hysterectomy is recommended also when genital prolaps occurs.recommended also when genital prolaps occurs.

The Laparoscopic Hysterectomy has lower costs because The Laparoscopic Hysterectomy has lower costs because the hospitalisation is shorter, it is minimally invasive and it can the hospitalisation is shorter, it is minimally invasive and it can be efficient as the classical technique, also it distinguish that be efficient as the classical technique, also it distinguish that the reason of conversion weren't iatrogenic errors. the reason of conversion weren't iatrogenic errors.

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ConclusionsConclusions The Laparoscopic Hysterectomy represents a feasible The Laparoscopic Hysterectomy represents a feasible

technique and it should be applied on every patient in the technique and it should be applied on every patient in the departments that are having Laparoscopic Instruments, but departments that are having Laparoscopic Instruments, but before applying this technique we need a good evaluation of before applying this technique we need a good evaluation of each patient. each patient.

The gynecologist surgeon also should be aware of the The gynecologist surgeon also should be aware of the possible difficulties that may appear during the surgery, and possible difficulties that may appear during the surgery, and he should inform the patient about a possible conversion into he should inform the patient about a possible conversion into LaparotomyLaparotomy

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ReferencesReferences** Sutton C. Hysterectomy: a historical perspective. Baillieres Sutton C. Hysterectomy: a historical perspective. Baillieres

Clin Obstet Gynaecol 1997; 11:1-22.Clin Obstet Gynaecol 1997; 11:1-22.

** Sutton C. Past, Present and Future of Hysterectomy. J Minim Sutton C. Past, Present and Future of Hysterectomy. J Minim Invasive Gynecol 2010; 17(4):421-35.Invasive Gynecol 2010; 17(4):421-35.

** The Regents of the University of Michigan Author: Laurie, The Regents of the University of Michigan Author: Laurie, Crimando RNC,MSN Reviewers: K., Wang, MD Last Revised Crimando RNC,MSN Reviewers: K., Wang, MD Last Revised 12/201012/2010

** WebSite GOOGLE WebSite GOOGLE

* * Williams Obstetrics 23Williams Obstetrics 23rdrd Edition Edition Copyright © 2010Copyright © 2010

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THANK YOUTHANK YOU

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