LAPAROSCOPIC RADICAL HYSTERECTOMY AND COMPLICATIONS, PREVENTION AND MANAGEMENT <ul><li>Dr. Pradeep  Garg Assistant Profess...
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  <ul><li>It is advisable to combine regional and general anesthesia for prolonged lap surgery </li></ul><ul><li...
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 <ul><li>Related to </li></ul><ul><ul><li>Stage of the disease </li></ul></ul><ul><ul><li>Site </li></...
Complications of LRH <ul><li>Vascular injuries  </li></ul><ul><li>Lower urinary tract injuries  </li></ul><ul><li>Bowel in...
Venous bleeding <ul><li>Ureteric tunnel </li></ul><ul><li>Cardinal ligament </li></ul><ul><li>Obturator fossa </li></ul>Ri...
Hemorrhagic  complications <ul><li>Mainly due to </li></ul><ul><ul><li>Direct major  blood vessels injury </li></ul></ul><...
Hemorrhagic complications <ul><li>PREVENTION </li></ul><ul><li>Thorough knowledge of vascular pelvic anatomy and vasculatu...
Bladder injury UB
Bladder injury <ul><li>Neurogenic bladder  </li></ul><ul><ul><li>Incidence 50% </li></ul></ul><ul><ul><ul><li>Hypertonic; ...
Ureteric injury <ul><li>Sites </li></ul><ul><ul><li>At the uv junction </li></ul></ul><ul><ul><li>Ischial spine  </li></ul...
Bowel injury
Bowel injury
Bowel injury <ul><li>HOW TO PREVENT? </li></ul><ul><li>Good bowel preparation </li></ul><ul><li>Anaesthesia  </li></ul><ul...
Genitofemoral Nerve
Obturator Nerve ( O.N )
Immediate post operative complication <ul><li>Mainly hemorrhagic due to </li></ul><ul><ul><li>Slippage of clip </li></ul><...
Thromboembolic episode <ul><li>Mainly due to venous stasis </li></ul><ul><li>Prophylaxis: </li></ul><ul><ul><li>Strapping ...
<ul><li>Laparoscopy in oncology first described in a non-gynae  malignancy (colon cancer) </li></ul><ul><li>- Safety prove...
Laparoscopy in Oncology <ul><li>Malignancy requires advanced operative laparoscopy </li></ul><ul><li>Extensive dissection ...
Conclusion <ul><li>Complications can be tackled laparoscopically </li></ul><ul><li>Remember that, complications are unavoi...
Thank You
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laparoscopic radical hysterectomy for carcinoma cervix Female Pelvic Anatomy Mob: 7289915430, www.drpradeepgarg

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laparoscopic radical hysterectomy for carcinoma cervix Female Pelvic Anatomy Mob: 7289915430, www.drpradeepgarg

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

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