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laparoscopic radical hysterectomy for carcinoma cervix

laparoscopic radical hysterectomy for carcinoma cervix

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laparoscopic radical hysterectomy for carcinoma cervix laparoscopic radical hysterectomy for carcinoma cervix Presentation Transcript

  • LAPAROSCOPIC RADICAL HYSTERECTOMY AND COMPLICATIONS, PREVENTION AND MANAGEMENT
    • Dr. Pradeep Garg Assistant Professor Obstetrics & Gynaecology, All India Institute of Medical Sciences New Delhi-110029
    • Email: pkgarg_in2004@yahoo.com
  • Ureter Video To see this video please logon to www.youtube.com and type Pradeep aiims
  • Lateral pelvic wall Video To see this video please logon to www.youtube.com and type Pradeep aiims
  • Anesthesia
    • It is advisable to combine regional and general anesthesia for prolonged lap surgery
    • Epidural catheter can also be used for postoperative pain relief
  • Patient Position Modified Llyod-Davis position Bolester
  • Port position Cephalic end
  • LRH Video To see this video please logon to www.youtube.com and type Pradeep aiims
  • Complications of LRH
    • Related to
      • Stage of the disease
      • Site
      • Surgeon
    • Can be divided into
      • Intraoperative
      • Immediate postoperative
      • Delayed
  • Complications of LRH
    • Vascular injuries
    • Lower urinary tract injuries
    • Bowel injuries
  • Venous bleeding
    • Ureteric tunnel
    • Cardinal ligament
    • Obturator fossa
    Right obturator fossa
  • Hemorrhagic complications
    • Mainly due to
      • Direct major blood vessels injury
      • Neovascularisation
  • Hemorrhagic complications
    • PREVENTION
    • Thorough knowledge of vascular pelvic anatomy and vasculature
    • Patient position
    Vascular Injury
  • Bladder injury UB
  • Bladder injury
    • Neurogenic bladder
      • Incidence 50%
        • Hypertonic; with decreased bladder capacity and increased resting pressure
        • Difficulty in initiating micturation
        • Loss of sensation of bladder fullness
    • Intraoperative measures
    • Postoperative management
      • Catheter drainage 4-7 days
      • Measure post void residual urine at the time of discharge
      • Avoid over distention of bladder
      • Periodic urine analysis
      • Urine output >200 ml to avoid UTI
    • VVF- infrequent complications
      • 1/3 of fistula following surgery heal spontaneously
  • Ureteric injury
    • Sites
      • At the uv junction
      • Ischial spine
      • Pelvic brim
  • Bowel injury
  • Bowel injury
  • Bowel injury
    • HOW TO PREVENT?
    • Good bowel preparation
    • Anaesthesia
    • Patient position
    • Nasogastric tube
    • Deflate tube
  • Genitofemoral Nerve
  • Obturator Nerve ( O.N )
  • Immediate post operative complication
    • Mainly hemorrhagic due to
      • Slippage of clip
      • Inadequate sealing of vessels
    • Management - Relap in stable pt
  • Thromboembolic episode
    • Mainly due to venous stasis
    • Prophylaxis:
      • Strapping of legs
      • Pneumatic stocking
      • Heparin
    • Laparoscopy in oncology first described in a non-gynae malignancy (colon cancer)
    • - Safety proven on randomised study
    • - Benefits
    • (Leung et al 2002, Lancet)
    Laparoscopy in Oncology
  • Laparoscopy in Oncology
    • Malignancy requires advanced operative laparoscopy
    • Extensive dissection
    • Expert laparoscopist
    • Overall complication rate acceptable
    • No compromise in oncological outcome
  • Conclusion
    • Complications can be tackled laparoscopically
    • Remember that, complications are unavoidable
    • but they should be recognized early
    • Conversion to open surgery is not a defeat but a victory over complication
  • Thank You