Apr 15, 2019 | 354 Views
This video presents the laparoscopic management of a large cervical fibroid through subtotal hysterectomy. If highlights the importance of access, visualization, anatomy, and hemostasis
Jul 5, 2019 | 288 Views
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.
Jul 8, 2019 | 447 Views
This video outlines tips and tricks to help navigate an enlarged uterus at the time of laparoscopic hysterectomy.
Jul 8, 2019 | 1556 Views
This video outlines two approaches to the suspension of the vaginal vault following total laparoscopic hysterectomy.
Sep 26, 2019 | 688 Views
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.
Sep 26, 2019 | 318 Views
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.
Sep 26, 2019 | 302 Views
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.
Sep 27, 2019 | 375 Views
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.
Sep 27, 2019 | 470 Views
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.
Oct 26, 2019 | 602 Views
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.
Sep 24, 2020 | 178 Views
This video reviews techniques to recreate pelvic supports and mitigate long term surgical complications of laparoscopic hysterectomy including: (1) ophoropexy and (2) vault suspension.