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MINILAP HYSTERECTOMY

MINILAP HYSTERECTOMY. DR.ARATI PATNAIK & PROF.SURENDRA NATH PANDA Dept. Of Obstetrics & Gynaecology M.K.C.G.MEDICAL COLLEGE BERHAMPUR-760004, ORISSA, INDIA. INTRODUCTION. MINILAPAROTOMY is an established surgical technique long established for female sterilisation.

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MINILAP HYSTERECTOMY

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  1. MINILAP HYSTERECTOMY DR.ARATI PATNAIK & PROF.SURENDRA NATH PANDA Dept. Of Obstetrics & Gynaecology M.K.C.G.MEDICAL COLLEGE BERHAMPUR-760004, ORISSA, INDIA

  2. INTRODUCTION • MINILAPAROTOMY is an established surgical technique long established for female sterilisation. • The same concept is extended to abdominal hysterectomy for benign conditions in selected patients. MINILAP HYSTERECTOMY - Dr.A.Patnaik & Prof.S.N.Panda

  3. PATIENT SELECTION • Average built patient • Mobile uterus less than 12 weeks size • Cervix can be pushed above symphysis pubis • Absence of large adenexal mass MINILAP HYSTERECTOMY - Dr.A.Patnaik & Prof.S.N.Panda

  4. MATERIALS • Period of study: - • Jan.99 to August, 2001 • Indication for hysterectomy • DUB 73 • Fibroid 15 • Adenomyosis 11 • Dysplasia 13 • Postmenopausal Bleeding 06 Total 118 MINILAP HYSTERECTOMY - Dr.A.Patnaik & Prof.S.N.Panda

  5. PROCEDURE • Suprapubic transverse incision, 5-6 cm. Long • No pack or retractor • Uterus delivered outside • With fingers or • After fixing with Myomectomy screw / Volsellum or • After Myomectomy MINILAP HYSTERECTOMY - Dr.A.Patnaik & Prof.S.N.Panda

  6. PROCEDURE • Hysterectomy with or without BSO done by standard procedure • Vagina closed with one or two interrupted sutures • Pelvic & parietal Peritonium not closed • Rectus sheath apposed with continuous suture • Routine & liberal use of diathermy MINILAP HYSTERECTOMY - Dr.A.Patnaik & Prof.S.N.Panda

  7. MINILAP HYSTERECTOMY The skin incision of 6cms length MINILAP HYSTERECTOMY - Dr.A.Patnaik & Prof.S.N.Panda

  8. MINILAP HYSTERECTOMY Uterus being delivered with a myomectomy screw MINILAP HYSTERECTOMY - Dr.A.Patnaik & Prof.S.N.Panda

  9. MINILAP HYSTERECTOMY Both sides infundibulopelvic ligaments have been cut MINILAP HYSTERECTOMY - Dr.A.Patnaik & Prof.S.N.Panda

  10. MINILAP HYSTERECTOMY Both cardinal ligaments have been cut & vault has been reached MINILAP HYSTERECTOMY - Dr.A.Patnaik & Prof.S.N.Panda

  11. MINILAP HYSTERECTOMY Cervix seen through the anterior opening in the vault MINILAP HYSTERECTOMY - Dr.A.Patnaik & Prof.S.N.Panda

  12. MINILAP HYSTERECTOMY Hysterectomy completed MINILAP HYSTERECTOMY - Dr.A.Patnaik & Prof.S.N.Panda

  13. MINILAP HYSTERECTOMY Skin incision is being closed MINILAP HYSTERECTOMY - Dr.A.Patnaik & Prof.S.N.Panda

  14. MINILAP HYSTERECTOMY Skin has been closed with two stitches MINILAP HYSTERECTOMY - Dr.A.Patnaik & Prof.S.N.Panda

  15. PROCEDURE Contd. • Suture material used - Vicryl no-1 • Routine & liberal use of diathermy • Skin closure • Interrupted mattress sutures(2-3) with polyamide no 1, or • Subcuticular stitch with vicryl rapide or • Nectacryl gel MINILAP HYSTERECTOMY - Dr.A.Patnaik & Prof.S.N.Panda

  16. PROCEDURE Contd. • Antibiotic prophylaxis- CEFTRIAXONE • 1 - 2 gm before induction of anaesthesia depending on body wt • 1gm after 24 hours • 1gm after 48 hours • Operating time- • 40 to 90 minutes, average 55 minutes MINILAP HYSTERECTOMY - Dr.A.Patnaik & Prof.S.N.Panda

  17. POSTOPERATIVE PERIOD • Catheter for 12 – 24 hours • Iv fluids for 12 to 24 hours • Analgesics as per need • Oral feeding after 6-12 hours • Full ambulation by 24 hours • Stitch removal after 96 hours • Fit for discharge on 4th day onwards MINILAP HYSTERECTOMY - Dr.A.Patnaik & Prof.S.N.Panda

  18. COMPLICATIONS • PYREXIA 6 • UTI 7 • AB WOUND INFECTION 4 • AB WOUND HAEMATOMA 1 • VAULT GRANULATION 2 MINILAP HYSTERECTOMY - Dr.A.Patnaik & Prof.S.N.Panda

  19. CONCLUSION • Mini lap hysterectomy is an easy to learn minimally invasive surgical procedure. • It has a shorter duration of surgery, faster recovery and reduced hospital stay. • The morbidity is very less as general peritoneal insult is avoided. MINILAP HYSTERECTOMY - Dr.A.Patnaik & Prof.S.N.Panda

  20. CONCLUSION • Considering the cost benefit, safety and the results are comparable with LAVH / NDVH with less operating time , but does not require expensive equipment or high-TEC training. • Considering the cost benefit and other advantages, it has a significant potential for use in developing counties particularly in rural hospitals. MINILAP HYSTERECTOMY - Dr.A.Patnaik & Prof.S.N.Panda

  21. Thank you Any Questions? Please Email-drsnpanda@hotmail.com MINILAP HYSTERECTOMY - Dr.A.Patnaik & Prof.S.N.Panda

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