Uterine Artery Ligation At The Origin | Surgical innovation
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Uterine Artery Ligation At The Origin | Surgical innovation |
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This Video Uploaded At 13-12-2024 13:53:30 |
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#UterineArteryLigation, #GynecologicalSurgery, #MinimalInvasiveSurgery, #Obstetrics, #PostpartumHemorrhage, #SurgicalTechniques, #UterineArtery, #PelvicSurgery, #FertilityPreservation, #ObGyn, #Hemostasis, #SurgicalInnovation, #LigationTechnique, #UterineHealth, #AdvancedSurgery, #ReproductiveHealth, #SurgicalTraining, #GynecologyUpdates, #WomensHealth, #ObstetricSurgery
Laparoscopic Uterine Artery Ligation at Origin is a minimally invasive surgical procedure often performed to control uterine bleeding or as a conservative treatment for conditions such as uterine fibroids or adenomyosis. The procedure involves identifying and ligating the uterine arteries at their origin, typically at the internal iliac arteries, to reduce blood supply to the uterus.
Steps of the Procedure:
1. Patient Positioning: Place the patient in a lithotomy position under general anesthesia. Use a steep Trendelenburg position to facilitate pelvic visualization.
2. Port Placement:
Use a standard laparoscopic port placement, including a 10-mm umbilical port for the camera and 5-mm accessory ports for instruments.
3. Identifying the Uterine Arteries:
The uterine arteries are branches of the internal iliac arteries.
Dissect the retroperitoneal space lateral to the uterine arteries, following the ureters' course.
4. Skeletonizing the Uterine Arteries:
Use blunt dissection and bipolar diathermy or harmonic scalpel to carefully expose the uterine arteries at their origin.
Take care to avoid injury to the ureters, which are located nearby.
5. Ligation or Coagulation:
The uterine arteries are ligated or coagulated at their origin from the internal iliac arteries. This can be achieved with:
Bipolar energy
Clips
Ties (less commonly)
6. Confirmation:
Ensure hemostasis and confirm the ligation by visualizing a lack of blood flow using Doppler if available.
7. Closure:
Irrigate the operative field to check for bleeding.
Close the port sites and ensure the patient is stable before extubation.
Indications:
Severe uterine bleeding (postpartum hemorrhage or uterine rupture).
Uterine fibroids (as a uterine-sparing alternative to hysterectomy).
Adenomyosis.
Conservative management for symptomatic relief.
Advantages:
Minimally invasive with reduced blood loss.
Uterine preservation for future fertility.
Shorter recovery time compared to open surgery.
Risks:
Ureteral injury (due to close anatomical proximity).
Incomplete arterial ligation leading to persistent symptoms.
Pelvic infection or hematoma.
Rare ischemic injury to the uterus or ovaries.
Postoperative Care:
Monitor for signs of bleeding or infection.
Ensure normal renal and uterine function.
Follow-up imaging (e.g., Doppler) may be necessary in some cases.
This technique requires advanced laparoscopic skills and thorough knowledge of pelvic anatomy. |
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