00:00
that everything else is okay she’s had
00:01
two normal deliveries so we do not
00:03
expect additions slight more head low
00:07
less so initially I prefer to put a 5 mm
00:17
put and we take a look again because of
00:30
a steep head low what happens is the
00:32
small bubble which has got some fluid
00:34
content tends to fall up towards the
00:36
diaphragm and the sigmoid you can simply
00:40
flip it up and it usually stays up
00:46
uterus is appearing normal can see both
00:50
the tubes very comfortably
00:58
now there is an option of whether you
01:00
want to put a dilator 2nt where the
01:03
uterus or not so in this case what I am
01:05
planning to do is to put in a dilator
01:26
separate carafe
01:31
out
01:38
so this is a simple dilator and it will
01:41
help to intimate support
01:57
now for the purpose of the finish
01:59
eclipse or for even for that matter the
02:03
band’s what you need to put is the 7mm
02:08
port so we remove the 5mm and from the
02:15
same put in the 7mm port
02:28
so the fill she clips they come with a
02:30
clip applicator some same thing
02:32
something similar to the band applicator
02:34
which is again a 7mm instrument
02:39
[Music]
02:55
[Music]
03:06
so this is the silly clip as you can see
03:10
it’s loaded onto the clip applicator and
03:13
this end is going to get pushed when I
03:17
squeeze this end will get pushed below
03:19
the outer end so then it seems and there
03:23
is silastic material in between which
03:26
will occlude the tube completely so when
03:30
I lift I can see that it goes below the
03:36
tube and the tube is going to get
03:44
squeezed
03:55
so this is the Phil Shi clip applied on
03:58
one tube so that silastic material is
04:02
going to cause the fibrosis of the part
04:05
of the tube only as much as it is held
04:07
inside the clip so this is minimum
04:10
trauma now we note the second clip
04:26
so again you can see that the second
04:28
clip is loaded so it is going to get
04:31
squeezed below the outer end and here
04:41
you can see the outer end much more
04:44
clearly and gently squeeze huh hello yes
04:56
this one I will talk you a little later
05:02
yeah so this is the second clip which is
05:07
now applied and it’s a very very
05:14
comfortable procedure that the amount of
05:16
damage is very very minimal so the
05:22
procedure is done now I prefer to give a
05:25
wash so what we are going to do is
05:27
remove the 7 mm again and from the same
05:31
port we put in the 5 mm and give a wash
05:37
I prefer to give a wash in every case
05:39
Plus leave around 7 to 800 CC of saline
05:42
at the end of every case so the
05:44
procedure actually takes hardly 3 to 4
05:46
minutes but I think compared to using a
05:49
band it’s much more comfortable to use
05:53
the fill she clip because there is
05:55
absolutely no extremist or trauma to the
05:58
patient when you use a band around two
06:01
and a half centimeter of the tube is
06:02
undergoing ischemia and that itself
06:05
causes significant pain in the
06:06
post-operative period to overcome that
06:09
pain when we were using the standard
06:12
tubular black bands I used to put sensor
06:15
cane into the broad ligament
06:17
5-cc of circle to a two to two and a
06:20
half CC on each side I would prefer to
06:23
put into the musical things over here so
06:26
the pain sensation was less in the
06:28
post-op period for those patients but
06:30
ever since we have started using the
06:31
fill she clips there is absolutely no
06:33
pain and it is almost as good as no
06:36
procedure has been done currently
06:42
this is very comfortable and again we
06:45
will leave around 7 800 cc or saline
06:47
inside it helps because we anyway don’t
06:50
give post-operative IV fluids plus it
06:54
helps in removing the gas so there is
06:57
absolutely no incidence of shoulder pain
06:59
to any of the patients undergo so very
07:08
comfortably placed and overweight sensor
07:14
cane and again we will put 5 to 10 CC of
07:19
sensor cane into the peritoneal cavity
07:21
now
07:37
fill the top
07:46
hello yes yes very good morning I want
07:56
to know I shot pussy and watch Anastasia
07:58
is preferred intubation is they you do
08:00
interest or incubation or a short either
08:03
listening we prefer to use GA for all
08:06
the cases Tara hear me yeah I can’t hear
08:10
you that yeah we prefer to use GA for
08:12
all the patients even if it is a small
08:14
procedure like the tubal ligation right
08:17
now ah the Jew interviewed intuition in
08:21
full gear with intubation what we have
08:23
been using is only laryngeal mask we
08:25
don’t intubate any of the patients even
08:27
for an instructor lower limb ectomy and
08:29
with luring air mask the anesthetic
08:32
agents which we prefer to use nowadays
08:33
even if the action has to be under for
08:36
only 10 minutes it’s equal to
08:38
comfortable I can’t hear you sir even if
08:43
we have to use it for 10 minutes it
08:46
comes actually in fully comfortable okay
08:49
okay yeah okay yeah thank you sir thank
08:52
you