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| Name | Approach to the Difficult Laparoscopic Hysterectomy: Enlarged Uterus |
| Video Uploader | Video From CanSAGE Secretariat |
| Upload Date | This Video Uploaded At 29-07-2023 04:34:55 |
| Video Discription | This educational video from the University of Ottawa’s Invasive Surgery Programme outlines a six-step approach to performing a laparoscopic hysterectomy on an enlarged uterus, emphasizing preoperative assessment, visualization, mobilization, and specimen removal techniques. Read the full transcript here: https://cansagevideos.com/approach-to-the-difficult-laparoscopic-hysterectomy-enlarged-uterus/ Presented By Dr. Sukhbir Sony Singh Dr. Neeraj Mehra Affiliate The University of Ottawa, The Ottawa Hospital Timestamps (00:27) Enlarged Uterus (01:18) Steps to Managing the Enlarged Uterus at Laparoscopic Hysterectomy (01:34) Step 1: Preoperative Assessment (02:42) Step 2: Optimize Visualization (03:27) Step 3: Early Intraoperative Assessment (04:36) Step 4: Mobilize Ligaments and Pedicles (05:05) Step 5: Secure Uterine Vessels Proximally (05:45) Morcellation and Specimen Removal The University of Ottawa presents a comprehensive video on managing an enlarged uterus during a laparoscopic hysterectomy as part of their educational series on surgical approaches. An enlarged uterus, which obscures the normal anatomy required for laparoscopic procedures, can be challenging to manage. Traditional teaching suggests laparotomy for such cases, but with advanced techniques, a laparoscopic approach is feasible and safe. The video details six essential steps for success. Firstly, a thorough preoperative assessment and decision-making process are critical. This includes evaluating uterine size, mobility, and the presence of masses or concomitant diagnoses like endometriosis. Preoperative optimization, such as managing anemia and reducing uterine size with GnRH agonists, is also advised. Secondly, optimizing visualization by placing laparoscopic ports higher than usual and using a 30-degree laparoscope is necessary to navigate the enlarged uterus. Early intraoperative assessment involves exploring the abdomen and pelvis to anticipate difficulties and decide on the surgical approach. The next steps involve mobilizing ligaments and pedicles to improve uterine mobility and securing uterine vessels proximally to manage potential bleeding. Finally, morcellation and specimen removal are addressed, with techniques varying depending on the surgery performed. Vaginal morcellation or a mini laparotomy incision for specimen removal can be employed for efficiency and safety. These systematic steps provide a structured approach to performing laparoscopic hysterectomies on enlarged uteri, aiming to improve surgical outcomes and patient safety. |
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