Hysterectomy past present & future

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Hysterectomy history, types and advances

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Hysterectomy past present & future

  1. 1. Sandesh Kamdi M.Pharm (Pharmacology)
  2. 2.  Vaginal  Abdominal  Laparoscopic  Robotic
  3. 3.  Vaginal hysterectomy (VH)  VH was performed by Themison of Athens in 50 BC by removing an inverted uterus that had become gangrenous.1  The first authenticated VH was performed by the Italian anatomist Berengario da Carpi of Bologna in 1507. 1. J Minim Invasive Gynecol 2010; 17(4):421-35. 2. Best Pract Res Clin Obstet Gynaecol 2005; 19:295-305.
  4. 4.  Self performed VH !!  In the early 17th century a 46-year-old peasant named Faith Haworth was carrying a heavy load when her uterus prolapsed completely.  Frustrated by this frequent occurrence, she grabbed her uterus, pulled as hard as possible, and cut the whole lot of it with a short knife.  The bleeding soon stopped and she lived on for many years, with a persistent vesico-vaginal fistula Clin Obstet Gynaecol 1997; 11:1-22.
  5. 5. One of the strongest proponents of vaginal hysterectomy  In 1934 he reported a series of 627 VH performed for benign pelvic disease, resulting in death in only three cases. Noble Sproat Heaney - Chicago Best Pract Res Clin Obstet Gynaecol 2005;19:295-305.
  6. 6. In the first part of 20th century, Before the development of gynaecology as separate speciality, many hysterectomies were done by general surgeons who, has not being familiar with vaginal surgery, favoured the abdominal route.
  7. 7.  Abdominal Hysterectomy The pathway to abdominal hysterectomy was laid down with the first laparotomy in the 19th century.  The human abdomen was deliberately surgically opened for the first time by Ephraim McDowell (Kentucky)  He successfully removed a 10.2 kg ovarian tumor without anaesthesia in 18095.  Ephraim McDowell (Kentucky) Baillieres Clin Obstet Gynaecol 1997; 11:1-22.
  8. 8.  Abdominal Hysterectomy He successfully removed a 10.2 kg ovarian tumor without anaesthesia in 18095.  McDowell operated on the kitchen table, performing an ovariotomy.  The operation lasted only 25 minutes, but was carefully planned.  After a rapid recovery, the patient lived for more than 30 years6.  Ephraim McDowell (Kentucky) Baillieres Clin Obstet Gynaecol 1997; 11:1-22.
  9. 9.  Radical Hysterectomy  Radical hysterectomy was initially developed as a surgical treatment for cervical cancer due to the absence of other modalities of treatment.  John Clark performed the first radical hysterectomy at Johns Hopkins Hospital, in 1895. Best Pract Res Clin Obstet Gynaecol 2005;19:387-401.
  10. 10.  Laparoscopic   Hysterectomy The first human laparoscopy was performed by Hans Christian Jacobaeus of Stockholm in 1911, by using pneumoperitoneum and the Nitze cystoscope. It was Raoul Palmer of France who popularised gynaecological laparoscopy in the 1940’s and who is considered to be the father of modern gynaecological laparoscopy doctoral thesis. Helsinki: Medical Faculty University of Helsinki;1999. Hans Christian Jacobaeus (Stockholm) Raoul Palmer (France)
  11. 11.  Robotic Laparoscopic Hysterectomy The first successful surgery using the da Vinci surgical system was performed in Belgium in 1997.  da Vinci S and da Vinci SI is equiped with double optic which gives the operator threedimensional view of the operative field, and with adjustable magnification, enabling much improved vision of the pelvis.  da Vinci surgical system
  12. 12. Fertility and Sterility 2005;84:1-11.
  13. 13.  Robotic Laparoscopic Hysterectomy  Radical hysterectomy performed using robotic techniques was comparable with laparotomy, with equal lymph node harvest, shorter operating time, and reduced blood loss and the length of hospital stay. da Vinci surgical system J Minim Invasive Gynecol 2010; 17(4):421-35.
  14. 14.  DaVinci System 1999: Introduced for surgical use  2000: Approved by FDA for performance of procedures in the abdomen and pelvis  2003, 2004: Approved by FDA for cardiac surgery, specifically MVR, Coronary Artery Bypass  2005: Approval by FDA for Robotic Hysterectomy  da Vinci surgical system
  15. 15.  Benefits         of robotics 3-Dimensional viewing Tremor filtration Intuitive movements 7 degree instrument movement 90 degree articulation Comfortable seated position for the surgeon Minimizes the number of needed assistants Telesurgery/telementoring
  16. 16.  Surgical dexterity and the robot  8-12% surgeons report pain or numbness after performing LSC  The robot allows for 7 degrees of motion versus the limited 4 degrees of motion in laparoscopy  Tremor is removed
  17. 17.  Trocar Placement Laparoscopic Robotic
  18. 18.  Vaginal hysterectomy is associated with better outcomes and fewer complications than laparoscopic or abdominal hysterectomy1.  A Cochrane Review of 34 RCTs: vaginal hysterectomy has the best outcomes over laparoscopic and abdominal hysterectomy2 1. Obstet Gynecol 2009;114:1156–1158. 2. Cochrane Database Syst Rev 2009; 3. CD003677.
  19. 19.  Limitation:  Laparoscopic vaginal hysterectomy is usually associated with higher cost and longer duration of operation and involves large number of specially trained personnel.
  20. 20.  60% of the patients without descent underwent successful removal of uterus.  Up to 16 weeks pregnancy size uterus were removed.  There were minimal surgical complications, blood loss, operative time or hospital stay.
  21. 21.  100 cases were taken for NDVH & 100 for AH.  Cases of Dysfunctional DUB, Uterine fibroid of less than 12wks, adenomyosis and cervical polyp, Previous LSCS with mobile uterus were included in the study Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530
  22. 22. Time (minutes) Duration of surgery 70 60 50 40 30 20 10 0 61 38 NDVH AH Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530
  23. 23. Post operative cathetarization 100% 100 80 % 60 40 21% 20 0 NDVH AH Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530
  24. 24. NDVH AH Early ambulation 6-14 hours 24-48 hours Regular diet Earlier Late Post Operative stay 2-3 days 5-7 days Complications rate Lower Higher Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530
  25. 25.  NDVH is least invasive route with least morbidity, least expensive technique & with most rapid postoperative recovery.  The absence of an abdominal incision leads to lower morbidity, less hospital stay, more rapid convalescence and patient compliance. Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 119S3 (2012) S261–S530
  26. 26.  100 patients with uterine size 8-10 weeks gestation  Age: 35.2±5.2 years  Mean parity: 4.17±1.5 Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
  27. 27. NDVH Duration of surgery 35.5 mins Mean hosp stay 3.5 days Blood loss 100-300 ml Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
  28. 28.  The new technique of aqua dissection in NDVH is easy, fast, safe and relatively less bleeding in modern gynecology Free communication (oral) presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S93–S396
  29. 29.  74 patients with uterine size 8-10 weeks gestation  Age: 35-55 years  Volume of uterus: 80-500 cm3
  30. 30. NDVH Duration of surgery 46 mins Mean hosp stay 48 hours Avg Blood loss 50 ml
  31. 31. • No abdominal wound • No significant destruction of intestine • Less post operative discomfort • Easier mobilization • Earlier discharge from hospital

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