Hellow guys, Welcome to my website, and you are watching HOW TO MAKE OVERIOTOMY AS AN EASY PROCEDURE IN CASES OF BIG OVERIAN CYSTS.. and this vIdeo is uploaded by Dr Some Gowda, MD, Obstetrics and Gynecology at 2025-04-10T07:48:40-07:00. We are pramote this video only for entertainment and educational perpose only. So, I hop you like our website.
| Name | HOW TO MAKE OVERIOTOMY AS AN EASY PROCEDURE IN CASES OF BIG OVERIAN CYSTS. |
| Video Uploader | Video From Dr Some Gowda, MD, Obstetrics and Gynecology |
| Upload Date | This Video Uploaded At 10-04-2025 14:48:40 |
| Video Discription | This issue is dedicated to practicing gynaecologist and post graduates. Many a times,fairly well clinically one can come to the conclusion that whether it will be benign or malignant. People believe, in big overian tumour think it as a malignant so that better prepared and managed intra operatively.If one is not competent reserve the necessary consultant by informed summoning. In my experience 90 -95% of the overian cyst were benign can be easily manageable by the general Gynaec consultants. Abdomen, invariably opened with the vertical incision under General anaesthesia so that the incision can be extendended above the umbellicus to deliver the cyst unruptured and secondary sites of deposits can be comfortably explored .But I believe that choice of anaesthesia is the choice of the Anaesthesist. As a matter of fact any mass per abdomen is LAPROTOMY and PROCESSED is the rule if not operable also. 1) One can take biopsy or peritonial washing sent for HPR ,chemosensitivity, histochemistry and genetic testing. 2)Staging laprotomy can be done to predict the course and prognosis of the disease.3) Intra peritoneal instillation of chemotherapetic agents can be done 4) if one is good can proceed with the cytoreductive procedure preventing morbidity ( intestinal obstruction common mode of death) and helping the Chemotherapist. Here I like to share my experience with two cases here. One enlarged towards antimesentric border and another towards mesentric border. One which enlarged towards antimesentric border will have a long pedical and in case of moderate size more chance of torsion , if the twist is more than 3-4 ovarian cyst is invariably gangrenous, urater in the base IP ligament may be lifted from lateral pelvic wall knuckle of it may be caught and cut so one should be careful. Untwisting the gangrenous cyst may diseminate the thrombotic material into the circulation can cause DIC and pulmonary embolism but rare. May be avoided by limiting the untwisting to two , gentle handling and applying the clamp near the mass may reduce the complication.usually thrombosis is in the venous wall and firmly adhered. In case of a BIG ovarian mass ,unlikely to undergo torsion and can removed by applying lateral clamp close to the mass and medial on the mesosulfinx and the ovarian ligament. One can ligated both sides of the stumps without applying the clamps advantage being more space and comfortably one can ligated acts as stay and prevent the retraction of the vessels while clamping. SECONDLY in case of BIG OVARIAN MASS enlarging towards the lateral pelvic wall either will be have a short pedical or no pedicle at all. Here , On LAPROTOMY the mass is having no pedical enlarging laterally splitting the two leaves of the IP ligament and ovarian Neurovascular close to the tumour wall,sitting on the vascular bundles of the left lower limb ,inferiorly enlarging towards the left rectal fossa sitting on the urater and on the obturater Neuro vascular bundle by splitting the two leaves of the broad ligament and covered superiorly, medically and anterior upper half by the sigmoid colon with its mesentry and lower by the advancement of the bladder. Here the mass is fixed and immobile difficult to eneucleate without rupture. The sigmoid colon was identified by the tenia coli and the apedices of epiploeca . Worked from identifying ligating and cutting the round ligament and pushing the bladder down. Ovarian neurovascular bundle were secured and ligatted, next sigmoid with its mesocolon was separated and finally mass was eneucleated without rupture from its bed and without injuring urater and the obturater vessels. SECONDLY in case of BIG OVARIAN MASS enlarging towards the lateral pelvic wall either will be have a short pedical or no pedicle at all. The sigmoid colon,covering the mass was stretched in such ways that it looks like a stip on it identified by the tanea coli and the apenges of epiploecae,separted and pushed laterally . Both IP and the round ligaments were clamped and ligatted and bladder was pushed down. The urater and the vascular structures of the pelvis forms the wall of cyst care fully separated without damaging them. Exploration of the pelvic structures at the end. This is not sigmoid colon, but is transverse colon , infracolic omentectomy was done. Since the vertical incision extended obove the umbilicus if the incision not closed properly may lead to the incisional hernia and it is a punishment especially in an over waited ladies and difficult to repair. Seniors eighter supervise or close themselves. I believe one can learn by practicing, better learnt by seeing the complications,still learnt by overcoming the complications successfully ,still the best is normally going home, but still, still the best is pt referring cases to you.Still I am a learner. Surgeon should understand and assess his assistants for successfulness of any procedures. |
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