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| Name | Approach to the Obliterated Cul-De-Sac |
| Video Uploader | Video From CanSAGE Secretariat |
| Upload Date | This Video Uploaded At 31-01-2023 23:46:27 |
| Video Discription | The video provides a detailed surgical approach to managing an obliterated cul-de-sac, emphasizing preoperative imaging, understanding key anatomical landmarks, and following a five-step method to optimize the excision of rectovaginal nodules while minimizing harm. Read the full transcript here: https://cansagevideos.com/approach-to-the-obliterated-cul-de-sac/ Presented By: Dr. Devon Evans Dr. Michael Suen Dr. Vincent della Zazzera Dr. Sukhbir Sony Singh Affiliations: University of Ottawa, The Ottawa Hospital Timestamps (00:05) Objectives (00:13) Transvaginal Ultrasound (TVUS) (01:18) Defining the Pararectal Space (01:40) Refining the Pararectal Space (02:19) Objectives (02:23) Systematic Approach to the Obliterated Cul-De-Sac (02:42) Preoperative Evaluation (03:01 - 05:46) Procedure Video (05:49) Systematic Approach to the Obliterated Cul-De-Sac This educational video outlines a surgical approach to the obliterated cul-de-sac, a condition often associated with endometriosis, where scar tissue and adhesions obstruct the pelvic anatomy. The video emphasizes the importance of preoperative evaluation, particularly high-quality imaging, which is crucial for identifying the extent of disease and planning the surgical approach. Dynamic ultrasound is highlighted as a key diagnostic tool, particularly in assessing the sliding sign to predict compartment obliteration. Expert imaging ensures that surprises are minimized in the operating room, allowing for a more controlled and effective surgical procedure. The video then moves on to discuss critical anatomical landmarks and the importance of understanding these structures to navigate the surgical approach successfully. The pararectal spaces, defined by the bowel, internal iliac artery, uterosacral ligament, and ureter, are key areas that need to be identified and developed during surgery. These spaces allow the surgeon to work in avascular zones, reducing the risk of injury to vital structures such as the bowel and ureters. The surgical approach to the obliterated cul-de-sac is presented as a five-step process: optimizing visualization, identifying relevant anatomy, developing pelvic spaces, excising the rectovaginal nodule, and confirming the integrity of the bowel. The video demonstrates this approach through a case example of a patient with infertility, pelvic pain, and bowel symptoms. The procedure begins with hydrotubation to confirm tubal patency and a thorough survey of the disease. Visualization is optimized through oophoropexy and ureterolysis, allowing for the clear identification of anatomical structures. Once the pararectal spaces are adequately developed, the rectovaginal nodule is excised using a meticulous dissection technique that avoids injury to the bowel and other critical structures. The video concludes by demonstrating the restoration of normal anatomy and performing a bowel insufflation test to confirm bowel integrity. An absorbable adhesion barrier is placed in the pelvis to prevent future adhesions. In summary, the video illustrates the importance of careful preoperative planning, a strong understanding of pelvic anatomy, and a systematic surgical approach to managing an obliterated cul-de-sac. The five-step method presented ensures that the procedure is performed with precision, minimizing the risk of complications and optimizing patient outcomes. |
| Category | People & Blogs |
| Tags | Cul-De-Sac | Obliterated Cul-De-Sac | Gynecology | preoperative consideration | anatomic landmarks | endometriomas | dynamic ultrasound | uterine immobility | posterior compartments | rectovaginal | static assessment |
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