Total Laparoscopic Hysterectomy Educational Tool

Apr 15, 2019 | 249 Views

Carmen McCaffrey, Brian Liu, Grace Liu, Rose Kung, Herb Wong, Abheha Satkunaratnam, Sari Kives, Jonathan Solnik, Andrea Simpson, Michael Secter, Jamie Kroft

A video-based educational tool to teach trainees how to perform the steps of a total laparoscopic hysterectomy.

Laparoscopic Subtotal Hysterectomy for a Large Cervical Fibroid

Apr 15, 2019 | 219 Views

Justin Mui, Fariba Mohtashami

This video presents the laparoscopic management of a large cervical fibroid through subtotal hysterectomy. If highlights the importance of access, visualization, anatomy, and hemostasis

Surgical Strategy for Tackling Cervical Myoma

Apr 15, 2019 | 191 Views

Jonathon Solnik, Ari Sanders

This video outlines tips and tricks for the management of cervical myomas utilizing three case examples.

Canadian Surgeons Demonstrate 101 Ways to Close a Cuff

Apr 15, 2019 | 156 Views

Alysha Nensi, Mara Sobel, Ally Murji

This video depicts the various ways used to closed the vaginal cuff at the time of laparoscopic hysterectomy.

Inbag Contained Morcellation: The New Era in MIGS

Jul 5, 2019 | 178 Views

Emilie Gorak Savard

This video demonstrates a technique for contained power morcellation in a bag during TLH for symptomatic fibroids. It also highlights tips and tricks to make the procedure easier.

Approach to the Difficult Laparoscopic Hysterectomy: Enlarged Uterus

Jul 8, 2019 | 326 Views

Neeraj Mehra, Sukhbir Sony Singh

This video outlines tips and tricks to help navigate an enlarged uterus at the time of laparoscopic hysterectomy.

Two Methods for Vaginal Vault Suspension at Total Laparoscopic Hysterectomy

Jul 8, 2019 | 1409 Views

Michael Chaikof, Ari Sanders, May Alarab, Colleen McDermott, Mara Sobel

This video outlines two approaches to the suspension of the vaginal vault following total laparoscopic hysterectomy.

Approach to the Total Laparoscopic Hysterectomy for a Didelphys Uterus

Sep 26, 2019 | 346 Views

Brenna Swift, Arthur Zaltz, Carmen McCaffrey

Didelphys uterus occurs with incomplete fusion of the Mullerian ducts, generating two uterine cavities, two cervices and a longitudinal vaginal septum. The incidence of Mullerian anomalies is 0.5-5% in the general population with didelphys uterus representing 8.3% of all Mullerian anomalies.Our surgical case is a 41 year old G2P2 female with Lynch syndrome. Upon completion of childbearing, she elected to undergo a risk-reducing hysterectomy and bilateral salpingo-oophorectomy. She had a known didelphys uterus and had 2 previous cesarean sections. An approach to a total laparoscopic hysterectomy for didelphys uterus is not widely described in literature. This video highlights surgical techniques to overcome unique challenges associated with a didelphys uterus. We demonstrate identification of renal anomalies associated with didelphys uterus, ligation of the uterine artery at the origin and techniques for dissection of the bladder flap after two previous cesarean sections to facilitate a wider colpotomy.

Laparoscopic Hysterectomy with Cervicovaginal Agenesis

Sep 26, 2019 | 189 Views

Rupinder Dhaliwal, Liane Belland

We present a laparoscopic surgical approach for hysterectomy in Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome with cervicovaginal agenesis. Laparoscopic approaches for removal of uterine remnants have been published with only reports of laparotomy described for hysterectomy with cervicovaginal agenesis. We discuss the diagnosis, management considerations and preoperative planning for definitive surgical treatment of a patient with MRKH with cervicovaginal agenesis presenting initially with hematometra and pain. We show that laparoscopic hysterectomy is a viable and safe option in patients with cervicovaginal agenesis. The importance of preoperative imaging to rule out associated anomalies and assist in surgical planning is stressed. We highlight necessary alterations in surgical technique to overcome the lack of traction, identify potential anomalous vasculature and ultimately maintain hemostasis, clear delineation of surgical anatomy, and avoid injury. Tissue extraction through laparoscopic in bag morcellation is performed thus avoiding mini laparotomy altogether.

Challenges when Performing Laparoscopic Hysterectomy in Women with BMI ≥ 40

Sep 26, 2019 | 195 Views

Tina Ngan, Julie Vermeer, Darrien Rattray, John Thiel

Obesity has become a worldwide epidemic. In 2016, 15% of women aged 18 and over were obese. The prevalence of obesity in Canada has doubled since 1985. It is estimated that by the end of 2019, 21% of the Canadian population will be obese. In this video, we will review a total of seven potential challenges encountered when performing laparoscopic hysterectomy in women with BMI above 40. These include comorbidities, patient positioning, insufflation of the abdomen, accessory ports placement suboptimal exposure of surgical field, bladder dissection and vaginal cuff closure. Management options and technical tips will be discussed.

Routine Anterior Colpotomy Prior to Ligation of the Uterine Artery at the Time of Laparoscopic Hysterectomy

Sep 27, 2019 | 231 Views

Angela Deane, Liane Belland

We present an alternative approach to securing the uterine pedicle during laparoscopic hysterectomy by initiating the colpotomy prior to uterine artery ligation. We review the traditional approach to securing the uterine pedicle and then demonstrate our alternative approach in a simple laparoscopic hysterectomy and in complex cases involving endometriosis and fibroidsCreation of the colpotomy prior to securing uterine arteries has several advantages. It improves surgical technique through clear delineation of anatomy, improving patient outcomes based on limited data and our experience. This technique improves surgical education and comfort with anatomy for learners. It is easy to teach and versatile for use in both simple and complex cases.

Manual Tissue Extraction: Approach to Vaginal Morcellation

Sep 27, 2019 | 231 Views

Alysha Nensi, Jennifer Liu, Deborah Robertson

Vaginal morcellation is a manual tissue extraction technique used to remove large specimens following robotic, laparoscopic, or vaginal hysterectomy. This procedure allows the surgeon to offer minimally invasive options to select patient populations and circumvents the need for laparotomy for specimen extraction. In recent years, there have been concerns regarding morcellation and the potential for inadvertent dissemination of malignant tissue. However, with appropriate patient selection and thorough pre-operative evaluation, the risks are low, particularly when the specimen is morcellated vaginally. The objective of this video is to describe the technique and equipment required for vaginal morcellation following laparoscopic hysterectomy. The case is a 43-year-old G3P3 female with abnormal uterine bleeding due to a multi-fibroid uterus, who underwent a total laparoscopic hysterectomy, bilateral salpingectomy, cystoscopy and vaginal morcellation. In this video, we demonstrate a safe and effective vaginal morcellation technique performed with bisection of the uterus, sequential wedge resections and myomectomy.

Lateral Approach to Uterine Artery & Scarred Bladder in Difficult TLH

Oct 26, 2019 | 482 Views

Li-Hsuan Hsiao, Fariba Mohtashami

Ligating the uterine arteries is a key step in successfully performing a total laparoscopic hysterectomy. However, in the presence of pelvic pathology, the anatomy can be significantly distorted making visibility and accessibility difficult. Securing the uterine arteries at the origins of the internal artery is a useful technique for any gynecologists performing hysterectomies. In this total laparoscopic hysterectomy, we encountered an obliterated anterior cul-de-sac from the previous Caesarean section scar and an inaccessible posterior cul-de-sac from a large posterior fibroid. Since it was not possible to ligate the uterine arteries at the level of the internal cervical os, we decided to use the lateral approach to ligate the uterine arteries by dissecting the pararectal fossa. This video aims to highlight the importance of identifying landmarks, hemostatic dissection, and adaptive intraoperative planning.

Recreating Pelvic Supports After Total Laparoscopic Hysterectomy

Sep 24, 2020 | 29 Views

Chelsie Warshafsky, Michael Chaikof, May Alarab, Ally Murji, Mara Sobel

This video reviews techniques to recreate pelvic supports and mitigate long term surgical complications of laparoscopic hysterectomy including: (1) ophoropexy and (2) vault suspension.