Hysterectomy past present & future

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Hysterectomy history, types and advances

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<ul><li> 1. Sandesh Kamdi M.Pharm (Pharmacology)</li></ul> <p> 2. Vaginal Abdominal Laparoscopic Robotic 3. Vaginalhysterectomy (VH)VH was performed by Themison of Athens in 50 BC by removing an inverted uterus that had become gangrenous.1The first authenticated VH was performed by the Italian anatomist Berengario da Carpi of Bologna in 1507.1. J Minim Invasive Gynecol 2010; 17(4):421-35. 2. Best Pract Res Clin Obstet Gynaecol 2005; 19:295-305. 4. Selfperformed VH !!In the early 17th century a 46-year-old peasant named Faith Haworth was carrying a heavy load when her uterus prolapsed completely.Frustrated by this frequent occurrence, she grabbed her uterus, pulled as hard as possible, and cut the whole lot of it with a short knife.The bleeding soon stopped and she lived on for many years, with a persistent vesico-vaginal fistula Clin Obstet Gynaecol 1997; 11:1-22. 5. One of the strongest proponents of vaginal hysterectomy In1934 he reported a series of 627 VH performed for benign pelvic disease, resulting in death in only three cases.Noble Sproat Heaney - ChicagoBest Pract Res Clin Obstet Gynaecol 2005;19:295-305. 6. In the first part of 20th century, Before the development of gynaecology as separate speciality, many hysterectomies were done by general surgeons who, has not being familiar with vaginal surgery, favoured the abdominal route. 7. Abdominal Hysterectomy The pathway to abdominal hysterectomy was laid down with the first laparotomy in the 19th century. The human abdomen was deliberately surgically opened for the first time by Ephraim McDowell (Kentucky) He successfully removed a 10.2 kg ovarian tumor without anaesthesia in 18095. Ephraim McDowell (Kentucky) Baillieres Clin Obstet Gynaecol 1997; 11:1-22. 8. Abdominal Hysterectomy He successfully removed a 10.2 kg ovarian tumor without anaesthesia in 18095. McDowell operated on the kitchen table, performing an ovariotomy. The operation lasted only 25 minutes, but was carefully planned. After a rapid recovery, the patient lived for more than 30 years6. Ephraim McDowell (Kentucky) Baillieres Clin Obstet Gynaecol 1997; 11:1-22. 9. RadicalHysterectomyRadical hysterectomy was initially developed as a surgical treatment for cervical cancer due to the absence of other modalities of treatment.John Clark performed the first radical hysterectomy at Johns Hopkins Hospital, in 1895.Best Pract Res Clin Obstet Gynaecol 2005;19:387-401. 10. Laparoscopic HysterectomyThe first human laparoscopy was performed by Hans Christian Jacobaeus of Stockholm in 1911, by using pneumoperitoneum and the Nitze cystoscope. It was Raoul Palmer of France who popularised gynaecological laparoscopy in the 1940s and who is considered to be the father of modern gynaecological laparoscopydoctoral thesis. Helsinki: Medical Faculty University of Helsinki;1999.Hans Christian Jacobaeus (Stockholm)Raoul Palmer (France) 11. RoboticLaparoscopic Hysterectomy The first successful surgery using the da Vinci surgical system was performed in Belgium in 1997. da Vinci S and da Vinci SI is equiped with double optic which gives the operator threedimensional view of the operative field, and with adjustable magnification, enabling much improved vision of the pelvis. da Vinci surgical system 12. Fertility and Sterility 2005;84:1-11. 13. Robotic Laparoscopic Hysterectomy Radical hysterectomy performed using robotic techniques was comparable with laparotomy, with equal lymph node harvest, shorter operating time, and reduced blood loss and the length of hospital stay. da Vinci surgical systemJ Minim Invasive Gynecol 2010; 17(4):421-35. 14. DaVinciSystem1999: Introduced for surgical use 2000: Approved by FDA for performance of procedures in the abdomen and pelvis 2003, 2004: Approved by FDA for cardiac surgery, specifically MVR, Coronary Artery Bypass 2005: Approval by FDA for Robotic Hysterectomy da Vinci surgical system 15. Benefits of robotics3-Dimensional viewing Tremor filtration Intuitive movements 7 degree instrument movement 90 degree articulation Comfortable seated position for the surgeon Minimizes the number of needed assistants Telesurgery/telementoring 16. Surgicaldexterity and therobot 8-12% surgeons report pain or numbness after performing LSCThe robot allows for 7 degrees of motion versus the limited 4 degrees of motion in laparoscopyTremor is removed 17. TrocarPlacementLaparoscopicRobotic 18. Vaginal hysterectomy is associated with better outcomes and fewer complications than laparoscopic or abdominal hysterectomy1.A Cochrane Review of 34 RCTs: vaginal hysterectomy has the best outcomes over laparoscopic and abdominal hysterectomy21. Obstet Gynecol 2009;114:11561158. 2. Cochrane Database Syst Rev 2009; 3. CD003677. 19. Limitation: Laparoscopicvaginal hysterectomy is usually associated with higher cost and longer duration of operation and involves large number of specially trained personnel. 20. 60%of the patients without descent underwent successful removal of uterus. Up to 16 weeks pregnancy size uterus were removed. There were minimal surgical complications, blood loss, operative time or hospital stay. 21. 100cases were taken for NDVH &amp; 100 forAH. Casesof Dysfunctional DUB, Uterine fibroid of less than 12wks, adenomyosis and cervical polyp, Previous LSCS with mobile uterus were included in the studyFree communication (oral) presentations / International Journal of Gynecology &amp; Obstetrics 119S3 (2012) S261S530 22. Time (minutes)Duration of surgery 70 60 50 40 30 20 10 061 38NDVHAHFree communication (oral) presentations / International Journal of Gynecology &amp; Obstetrics 119S3 (2012) S261S530 23. Post operative cathetarization 100% 100 80%60 4021%20 0 NDVHAHFree communication (oral) presentations / International Journal of Gynecology &amp; Obstetrics 119S3 (2012) S261S530 24. NDVHAHEarly ambulation6-14 hours24-48 hoursRegular dietEarlierLatePost Operative stay2-3 days5-7 daysComplications rateLowerHigherFree communication (oral) presentations / International Journal of Gynecology &amp; Obstetrics 119S3 (2012) S261S530 25. NDVHis least invasive route with least morbidity, least expensive technique &amp; with most rapid postoperative recovery. Theabsence of an abdominal incision leads to lower morbidity, less hospital stay, more rapid convalescence and patient compliance.Free communication (oral) presentations / International Journal of Gynecology &amp; Obstetrics 119S3 (2012) S261S530 26. 100patients with uterine size 8-10 weeks gestation Age: 35.25.2 years Mean parity: 4.171.5Free communication (oral) presentations / International Journal of Gynecology &amp; Obstetrics 107S2 (2009) S93S396 27. NDVH Duration of surgery35.5 minsMean hosp stay3.5 daysBlood loss100-300 mlFree communication (oral) presentations / International Journal of Gynecology &amp; Obstetrics 107S2 (2009) S93S396 28. Thenew technique of aqua dissection in NDVH is easy, fast, safe and relatively less bleeding in modern gynecologyFree communication (oral) presentations / International Journal of Gynecology &amp; Obstetrics 107S2 (2009) S93S396 29. 74patients with uterine size 8-10 weeks gestation Age: 35-55 years Volume of uterus: 80-500 cm3 30. NDVH Duration of surgery46 minsMean hosp stay48 hoursAvg Blood loss50 ml 31. No abdominal wound No significant destruction of intestine Less post operative discomfort Easier mobilization Earlier discharge from hospital </p>