{"id":322,"date":"2020-08-13T17:55:56","date_gmt":"2020-08-13T17:55:56","guid":{"rendered":"https:\/\/brooksidepress.org\/basic_obgyn\/?page_id=322"},"modified":"2020-08-13T17:55:56","modified_gmt":"2020-08-13T17:55:56","slug":"basic-robotic-total-laparoscopic-hysterectomy","status":"publish","type":"page","link":"https:\/\/brooksidepress.org\/pa_obgyn\/surgery-2\/basic-robotic-total-laparoscopic-hysterectomy\/","title":{"rendered":"Basic Robotic Total Laparoscopic Hysterectomy"},"content":{"rendered":"<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/XUJpCOIoDHY\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>Duration: 12:53<\/p>\n<input type='hidden' bg_collapse_expand='69e9b567eaeb15015731526' value='69e9b567eaeb15015731526'><input type='hidden' id='bg-show-more-text-69e9b567eaeb15015731526' value='Show Transcript'><input type='hidden' id='bg-show-less-text-69e9b567eaeb15015731526' value='Hide Transcript'><button id='bg-showmore-action-69e9b567eaeb15015731526' class='bg-showmore-plg-button bg-blue-button  '   style=\" color:#ffffff;\">Show Transcript<\/button><div id='bg-showmore-hidden-69e9b567eaeb15015731526' ><\/p>\n<p>00:00<br \/>\nthis video is a typical example of a<br \/>\n00:02<br \/>\nrobotic assistant total laparoscopic<br \/>\n00:03<br \/>\nhysterectomy due to large fibroids and<br \/>\n00:06<br \/>\nmini Rajah the patient is a 44 year old<br \/>\n00:08<br \/>\nafrican-american female with multiple<br \/>\n00:10<br \/>\nuterine fibroids pelvic pain and mini<br \/>\n00:12<br \/>\nRaja<br \/>\n00:12<br \/>\nshe had an 18 week gestational sized<br \/>\n00:14<br \/>\nuterus on physical exam she was about to<br \/>\n00:17<br \/>\nbegin a new job and desired a minimally<br \/>\n00:18<br \/>\ninvasive laparoscopic hysterectomy at<br \/>\n00:22<br \/>\nthe initial survey the enlarged uterus<br \/>\n00:24<br \/>\nand multiple fibroids can be seen the<br \/>\n00:27<br \/>\nprocedure is performed using the ACE<br \/>\n00:29<br \/>\nharmonic scalpel the procedure has began<br \/>\n00:32<br \/>\nwith a soft injected me by cutting them<br \/>\n00:34<br \/>\nas a sow pace with the harmonic scalpel<br \/>\n00:35<br \/>\na routinely perform &#8216;south injected me<br \/>\n00:38<br \/>\nat the time of hysterectomy as leaving<br \/>\n00:40<br \/>\nthe tubes behind serves no purpose but<br \/>\n00:42<br \/>\nthey increase the chance of developing a<br \/>\n00:43<br \/>\nHydra sow things down the road the utero<br \/>\n00:47<br \/>\nVarian and then round ligament is<br \/>\n00:49<br \/>\ndivided<br \/>\n00:56<br \/>\nyou<br \/>\n01:03<br \/>\nyou<br \/>\n01:10<br \/>\nyou<br \/>\n01:15<br \/>\nas the broad ligament is open the and<br \/>\n01:18<br \/>\nhere bladder flap has created<br \/>\n01:34<br \/>\nas the bra blinkman is open the uterine<br \/>\n01:37<br \/>\nartery seen here is then skeletonized<br \/>\n01:56<br \/>\nthe harmonic is then used to coagulate<br \/>\n01:59<br \/>\nthe uterine artery in multiple places<br \/>\n02:01<br \/>\nbefore transected<br \/>\n02:05<br \/>\nyou<br \/>\n02:29<br \/>\nthe descending branch of the uterine<br \/>\n02:31<br \/>\nartery has then coagulated<br \/>\n02:40<br \/>\nattention is then turned to the opposite<br \/>\n02:42<br \/>\nside I have swap locations of the<br \/>\n02:45<br \/>\ntenaculum in the harmonic scalpel<br \/>\n03:06<br \/>\nwith a laparoscopic hysterectomy and<br \/>\n03:09<br \/>\nparticularly with a large uterus it is<br \/>\n03:11<br \/>\nimportant to transect the round ligament<br \/>\n03:13<br \/>\nin its midpoint or just slightly lateral<br \/>\n03:15<br \/>\nto this area this both facilitates<br \/>\n03:17<br \/>\napproaching the uterine artery at the<br \/>\n03:19<br \/>\nproper angle and stays away from the<br \/>\n03:21<br \/>\nlarge vessel surrounding the uterus<br \/>\n04:10<br \/>\nthe anterior peritoneum dissection has<br \/>\n04:13<br \/>\ncontinued to meet that of the other side<br \/>\n04:58<br \/>\nagain the uterine vessels are<br \/>\n05:00<br \/>\nskeletonized<br \/>\n05:03<br \/>\nTheatre and artery is located here with<br \/>\n05:07<br \/>\nthe uterine vein just behind it the<br \/>\n05:10<br \/>\nuterine vein is coagulated first<br \/>\n05:17<br \/>\nfollowed by the Maine<br \/>\n05:26<br \/>\nthe artery is then fully divided<br \/>\n05:53<br \/>\nthe Cardinal ligament is then divided<br \/>\n05:54<br \/>\naiming towards the edge of the coat<br \/>\n05:57<br \/>\ncalled pata miser cup as the Cardinal<br \/>\n06:05<br \/>\nligament is divided the uterine artery<br \/>\n06:06<br \/>\nbegins to fall laterally<br \/>\n06:30<br \/>\nthe cervical fashio is thinned all the<br \/>\n06:32<br \/>\nway around the cup as the bladder was<br \/>\n06:38<br \/>\nnot able to be dissected down at the<br \/>\n06:39<br \/>\ninitial steps is pushed down at this<br \/>\n06:42<br \/>\npoint the Kolkata me is then began with<br \/>\n07:00<br \/>\nthe harmonic scalpel the cocoa atomizer<br \/>\n07:03<br \/>\ncup can be seen here the uterus has<br \/>\n07:07<br \/>\npushed inward with the uterine<br \/>\n07:09<br \/>\nmanipulator which places pressure on the<br \/>\n07:10<br \/>\nvagina thinning out the tissue overlying<br \/>\n07:12<br \/>\nthat cope atomizer cup approximately 2\/3<br \/>\n07:22<br \/>\nof Kolkata me is performed from one side<br \/>\n07:30<br \/>\nattention then turns back to the right<br \/>\n07:31<br \/>\nside where the final dissection of the<br \/>\n07:33<br \/>\nCardinal ligament and thinning out is<br \/>\n07:35<br \/>\nperformed<br \/>\n07:56<br \/>\ncompletion of the co pada we can then be<br \/>\n07:58<br \/>\nperformed<br \/>\n08:08<br \/>\nonce full disconnection is achieved the<br \/>\n08:11<br \/>\nuterus is pulled into the vagina in this<br \/>\n08:16<br \/>\ncase vaginal Morse elation was performed<br \/>\n08:19<br \/>\nas this patient had one large 8<br \/>\n08:21<br \/>\ncentimeter fibroid the uterus was turned<br \/>\n08:23<br \/>\nwith the body of the Rieu turrets<br \/>\n08:25<br \/>\nremoved from the fibroid and then the<br \/>\n08:27<br \/>\nfibroid taken out separately<br \/>\n08:41<br \/>\nthe body of the large fibroid is kept in<br \/>\n08:43<br \/>\nthe vagina to maintain the<br \/>\n08:45<br \/>\npneumoperitoneum cuff closures that<br \/>\n08:47<br \/>\nbegan using a 0 v lock barbed suture<br \/>\n08:55<br \/>\nas the uterine vessels can be seen here<br \/>\n08:57<br \/>\ncare is taken to place the suture inside<br \/>\n08:59<br \/>\nof their margin in particular care is<br \/>\n09:02<br \/>\ntaken to grab good bytes of the vaginal<br \/>\n09:04<br \/>\nmucosa<br \/>\n09:08<br \/>\nbut once the initial corner bite is<br \/>\n09:11<br \/>\nplaced the 0v lock suture is looped back<br \/>\n09:13<br \/>\non itself the closure is then continued<br \/>\n09:22<br \/>\nin a running fashion along the way<br \/>\n09:25<br \/>\nensuring that the bladder is<br \/>\n09:26<br \/>\nappropriately dissected away from the<br \/>\n09:28<br \/>\nvaginal cuff<br \/>\n10:12<br \/>\nyou<br \/>\n10:18<br \/>\nthis patient had a portion of deep<br \/>\n10:20<br \/>\ninfiltrating endometriosis and this<br \/>\n10:22<br \/>\nposterior peritoneum that&#8217;s that it is<br \/>\n10:24<br \/>\nnot incorporated in this middle area in<br \/>\n10:26<br \/>\nanticipation of coming back and<br \/>\n10:27<br \/>\ndissecting out this area of<br \/>\n10:29<br \/>\nendometriosis<br \/>\n10:53<br \/>\nyou<br \/>\n11:06<br \/>\nas I close the cuff with a single<br \/>\n11:09<br \/>\nrunning suture from right to left that<br \/>\n11:10<br \/>\ntake care not to fully tighten down the<br \/>\n11:12<br \/>\nfinal sutures so that the vaginal mucosa<br \/>\n11:14<br \/>\ncorner can be clearly located prior to<br \/>\n11:16<br \/>\ncompletion of the cuff closure<br \/>\n11:27<br \/>\nyou<br \/>\n11:35<br \/>\nonce I have placed the last few sutures<br \/>\n11:37<br \/>\nI will then go back and tighten down the<br \/>\n11:39<br \/>\nbarb to be lock suture<br \/>\n12:09<br \/>\nthe case is now complete the small area<br \/>\n12:11<br \/>\nof endometriosis was fully excised<br \/>\n12:16<br \/>\npathology revealed multiple uterine<br \/>\n12:18<br \/>\nfibroids ranging from zero point seven<br \/>\n12:20<br \/>\nto eight centimeters in significant<br \/>\n12:22<br \/>\nareas of adenomyosis the total urine<br \/>\n12:24<br \/>\nweight was 856 grand<br \/>\n12:26<br \/>\nthe estimated blood loss was 50 CCS<br \/>\n12:29<br \/>\nsurgical times were 35 minutes to<br \/>\n12:31<br \/>\nremoval the uterus 14 minutes for<br \/>\n12:33<br \/>\nvaginal more sedation in 10 minutes for<br \/>\n12:35<br \/>\nthe cuff closure the patient went home<br \/>\n12:37<br \/>\nthe same day from the recovery here she<br \/>\n12:39<br \/>\nwas able to begin a new job only ten<br \/>\n12:41<br \/>\ndays later<br \/>\n12:50<br \/>\nyou<\/p>\n<p><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Duration: 12:53<\/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-322","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/322","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=322"}],"version-history":[{"count":0,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/322\/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=322"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}