{"id":284,"date":"2020-08-13T17:36:10","date_gmt":"2020-08-13T17:36:10","guid":{"rendered":"https:\/\/brooksidepress.org\/basic_obgyn\/?page_id=284"},"modified":"2020-08-13T17:36:10","modified_gmt":"2020-08-13T17:36:10","slug":"tubal-ligation-with-filshie-clips","status":"publish","type":"page","link":"https:\/\/brooksidepress.org\/pa_obgyn\/surgery-2\/tubal-ligation-with-filshie-clips\/","title":{"rendered":"Tubal Ligation with Clips"},"content":{"rendered":"<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/m9Wc0QkMxaU\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>Duration 8:57<\/p>\n<input type='hidden' bg_collapse_expand='69e9c8f4d9ea97088918162' value='69e9c8f4d9ea97088918162'><input type='hidden' id='bg-show-more-text-69e9c8f4d9ea97088918162' value='Show Transcript'><input type='hidden' id='bg-show-less-text-69e9c8f4d9ea97088918162' value='Hide Transcript'><button id='bg-showmore-action-69e9c8f4d9ea97088918162' class='bg-showmore-plg-button bg-blue-button  '   style=\" color:#ffffff;\">Show Transcript<\/button><div id='bg-showmore-hidden-69e9c8f4d9ea97088918162' ><\/p>\n<p>00:00<br \/>\nthat everything else is okay she&#8217;s had<br \/>\n00:01<br \/>\ntwo normal deliveries so we do not<br \/>\n00:03<br \/>\nexpect additions slight more head low<br \/>\n00:07<br \/>\nless so initially I prefer to put a 5 mm<br \/>\n00:17<br \/>\nput and we take a look again because of<br \/>\n00:30<br \/>\na steep head low what happens is the<br \/>\n00:32<br \/>\nsmall bubble which has got some fluid<br \/>\n00:34<br \/>\ncontent tends to fall up towards the<br \/>\n00:36<br \/>\ndiaphragm and the sigmoid you can simply<br \/>\n00:40<br \/>\nflip it up and it usually stays up<br \/>\n00:46<br \/>\nuterus is appearing normal can see both<br \/>\n00:50<br \/>\nthe tubes very comfortably<br \/>\n00:58<br \/>\nnow there is an option of whether you<br \/>\n01:00<br \/>\nwant to put a dilator 2nt where the<br \/>\n01:03<br \/>\nuterus or not so in this case what I am<br \/>\n01:05<br \/>\nplanning to do is to put in a dilator<br \/>\n01:26<br \/>\nseparate carafe<br \/>\n01:31<br \/>\nout<br \/>\n01:38<br \/>\nso this is a simple dilator and it will<br \/>\n01:41<br \/>\nhelp to intimate support<br \/>\n01:57<br \/>\nnow for the purpose of the finish<br \/>\n01:59<br \/>\neclipse or for even for that matter the<br \/>\n02:03<br \/>\nband&#8217;s what you need to put is the 7mm<br \/>\n02:08<br \/>\nport so we remove the 5mm and from the<br \/>\n02:15<br \/>\nsame put in the 7mm port<br \/>\n02:28<br \/>\nso the fill she clips they come with a<br \/>\n02:30<br \/>\nclip applicator some same thing<br \/>\n02:32<br \/>\nsomething similar to the band applicator<br \/>\n02:34<br \/>\nwhich is again a 7mm instrument<br \/>\n02:39<br \/>\n[Music]<br \/>\n02:55<br \/>\n[Music]<br \/>\n03:06<br \/>\nso this is the silly clip as you can see<br \/>\n03:10<br \/>\nit&#8217;s loaded onto the clip applicator and<br \/>\n03:13<br \/>\nthis end is going to get pushed when I<br \/>\n03:17<br \/>\nsqueeze this end will get pushed below<br \/>\n03:19<br \/>\nthe outer end so then it seems and there<br \/>\n03:23<br \/>\nis silastic material in between which<br \/>\n03:26<br \/>\nwill occlude the tube completely so when<br \/>\n03:30<br \/>\nI lift I can see that it goes below the<br \/>\n03:36<br \/>\ntube and the tube is going to get<br \/>\n03:44<br \/>\nsqueezed<br \/>\n03:55<br \/>\nso this is the Phil Shi clip applied on<br \/>\n03:58<br \/>\none tube so that silastic material is<br \/>\n04:02<br \/>\ngoing to cause the fibrosis of the part<br \/>\n04:05<br \/>\nof the tube only as much as it is held<br \/>\n04:07<br \/>\ninside the clip so this is minimum<br \/>\n04:10<br \/>\ntrauma now we note the second clip<br \/>\n04:26<br \/>\nso again you can see that the second<br \/>\n04:28<br \/>\nclip is loaded so it is going to get<br \/>\n04:31<br \/>\nsqueezed below the outer end and here<br \/>\n04:41<br \/>\nyou can see the outer end much more<br \/>\n04:44<br \/>\nclearly and gently squeeze huh hello yes<br \/>\n04:56<br \/>\nthis one I will talk you a little later<br \/>\n05:02<br \/>\nyeah so this is the second clip which is<br \/>\n05:07<br \/>\nnow applied and it&#8217;s a very very<br \/>\n05:14<br \/>\ncomfortable procedure that the amount of<br \/>\n05:16<br \/>\ndamage is very very minimal so the<br \/>\n05:22<br \/>\nprocedure is done now I prefer to give a<br \/>\n05:25<br \/>\nwash so what we are going to do is<br \/>\n05:27<br \/>\nremove the 7 mm again and from the same<br \/>\n05:31<br \/>\nport we put in the 5 mm and give a wash<br \/>\n05:37<br \/>\nI prefer to give a wash in every case<br \/>\n05:39<br \/>\nPlus leave around 7 to 800 CC of saline<br \/>\n05:42<br \/>\nat the end of every case so the<br \/>\n05:44<br \/>\nprocedure actually takes hardly 3 to 4<br \/>\n05:46<br \/>\nminutes but I think compared to using a<br \/>\n05:49<br \/>\nband it&#8217;s much more comfortable to use<br \/>\n05:53<br \/>\nthe fill she clip because there is<br \/>\n05:55<br \/>\nabsolutely no extremist or trauma to the<br \/>\n05:58<br \/>\npatient when you use a band around two<br \/>\n06:01<br \/>\nand a half centimeter of the tube is<br \/>\n06:02<br \/>\nundergoing ischemia and that itself<br \/>\n06:05<br \/>\ncauses significant pain in the<br \/>\n06:06<br \/>\npost-operative period to overcome that<br \/>\n06:09<br \/>\npain when we were using the standard<br \/>\n06:12<br \/>\ntubular black bands I used to put sensor<br \/>\n06:15<br \/>\ncane into the broad ligament<br \/>\n06:17<br \/>\n5-cc of circle to a two to two and a<br \/>\n06:20<br \/>\nhalf CC on each side I would prefer to<br \/>\n06:23<br \/>\nput into the musical things over here so<br \/>\n06:26<br \/>\nthe pain sensation was less in the<br \/>\n06:28<br \/>\npost-op period for those patients but<br \/>\n06:30<br \/>\never since we have started using the<br \/>\n06:31<br \/>\nfill she clips there is absolutely no<br \/>\n06:33<br \/>\npain and it is almost as good as no<br \/>\n06:36<br \/>\nprocedure has been done currently<br \/>\n06:42<br \/>\nthis is very comfortable and again we<br \/>\n06:45<br \/>\nwill leave around 7 800 cc or saline<br \/>\n06:47<br \/>\ninside it helps because we anyway don&#8217;t<br \/>\n06:50<br \/>\ngive post-operative IV fluids plus it<br \/>\n06:54<br \/>\nhelps in removing the gas so there is<br \/>\n06:57<br \/>\nabsolutely no incidence of shoulder pain<br \/>\n06:59<br \/>\nto any of the patients undergo so very<br \/>\n07:08<br \/>\ncomfortably placed and overweight sensor<br \/>\n07:14<br \/>\ncane and again we will put 5 to 10 CC of<br \/>\n07:19<br \/>\nsensor cane into the peritoneal cavity<br \/>\n07:21<br \/>\nnow<br \/>\n07:37<br \/>\nfill the top<br \/>\n07:46<br \/>\nhello yes yes very good morning I want<br \/>\n07:56<br \/>\nto know I shot pussy and watch Anastasia<br \/>\n07:58<br \/>\nis preferred intubation is they you do<br \/>\n08:00<br \/>\ninterest or incubation or a short either<br \/>\n08:03<br \/>\nlistening we prefer to use GA for all<br \/>\n08:06<br \/>\nthe cases Tara hear me yeah I can&#8217;t hear<br \/>\n08:10<br \/>\nyou that yeah we prefer to use GA for<br \/>\n08:12<br \/>\nall the patients even if it is a small<br \/>\n08:14<br \/>\nprocedure like the tubal ligation right<br \/>\n08:17<br \/>\nnow ah the Jew interviewed intuition in<br \/>\n08:21<br \/>\nfull gear with intubation what we have<br \/>\n08:23<br \/>\nbeen using is only laryngeal mask we<br \/>\n08:25<br \/>\ndon&#8217;t intubate any of the patients even<br \/>\n08:27<br \/>\nfor an instructor lower limb ectomy and<br \/>\n08:29<br \/>\nwith luring air mask the anesthetic<br \/>\n08:32<br \/>\nagents which we prefer to use nowadays<br \/>\n08:33<br \/>\neven if the action has to be under for<br \/>\n08:36<br \/>\nonly 10 minutes it&#8217;s equal to<br \/>\n08:38<br \/>\ncomfortable I can&#8217;t hear you sir even if<br \/>\n08:43<br \/>\nwe have to use it for 10 minutes it<br \/>\n08:46<br \/>\ncomes actually in fully comfortable okay<br \/>\n08:49<br \/>\nokay yeah okay yeah thank you sir thank<br \/>\n08:52<br \/>\nyou<\/p>\n<p><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Duration 8:57<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":784,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-284","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/284","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/comments?post=284"}],"version-history":[{"count":0,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/284\/revisions"}],"up":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/784"}],"wp:attachment":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/media?parent=284"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}