3. • HAPPY
TO
ANNOUNCE
• MY
CENTRE
BEING
AFFILIATED
•
BY
FOGSI
-‐ICOG
• FOR
CERTIFICATE
COURSE
FOR
6
MONTHS
• ON
• VAGINAL
AND
PELVIC
RECONSTRUCTIVE
SURGERY
• FOR
POSTGRADUATES
IN
OBGYN
• FOR
DETAILS
LOG
IN
• WWW.FOGSI.ORG
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16. DR.
KAWITA
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ONE
DAY
HYSTERECTOMY
SPECIALIST
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17. Fibroids
Bleeding
Endometriosis
Pelvic
pain
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KAWITA
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Significant cost
to healthcare
system
By age 60
one in three
women
More than half a million
hysterectomies/year
23. Goal
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What
should
be the new selection
criteria
What are the
new
instrumentation
What is the fun
What is the
Technique
What
are
the Challenges
24. Vaginal
hysterectomy
How
to
Spot
Hot
Trends
Most
favourite
procedure
Developed
in the past
Need not
to be a
procedure
of the past
We cannot
allow it to
die
DR
KAWITA
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25. VAGINAL
HYSTERECTOMY
How
to
Spot
Hot
Trends
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KAWITA
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AMEN
keep the
procedure
alive
Trained
in
vaginal
surgery
vaginal
surgeon
26. Anatomy
of
a
Hot
Market
Evolution in Electro
surgery
Improved
tradiGonal
bipolar
Vessel
sealing
Bipolar
cuSng
Tissue
impedance
feedback
Improved
outcome
in
terms
of
the
Gssue
effect
Mono
polar
instrumentaRon
Conven&onal
bipolar
instrumentaRon
Advanced
bipolar
instrumentaRon
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KAWITA
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28. General principle
Three new
principle
Only 2 other
instruments
Application
of clamp
close to
uterus
No traction
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Classical steps of
conventional surgery
29. The
4
Decisions
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People
Strategy
ExecuRon
FUN
30. Sequence of operation
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Vaginal
circumferenRal
cut
around
Opening
of
posterior
peritoneum
Clamping
and
cuXng
of
ligaments
Clamping
and
cuXng
of
uterine
vessels
AmputaRon
of
uterus
Occlusion
of
vaginal
vault
Opening
of
Anterior
peritoneum
31. Technical
challenges
to
the
vaginal
approach:
• Exposure
• Haemostasis
•
Entry
into
the
cul-‐de-‐sac
•
Large
uterus
•
Ureteral
injury
•
High
adnexa
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32. One
Day
surgery
selecRon
criteria
• To
achieve
the
goals
of
paRent
selecRon
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KAWITA
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Is
there
anything
we
would
do
for
this
paRent
by
admiXng
them
overnight
which
could
not
be
done
at
home?
Is
the
operaRon
an
appropriate
day-‐care
procedure?
Are
the
paRent's
home
circumstances
adequate
for
day
surgery
discharge
33.
Make
ONE
point.
Keep
it
simple
Strategy
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KAWITA
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Remember
Difficult does not
mean one should
not try.
It means one
should try just
harder.
34. Criteria
in
Determining
the
Route
for
Hysterectomy
Level of
suspicion for
malignancy
What the size
of the uterus
Previous caesarian
section
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KAWITA
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35. Criteria
in
Determining
the
Route
for
Hysterectomy
Vaginal access
Presence
of
an
adnexal
mass
Assessment
of the
mobility of
the uterus
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KAWITA
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36. Entry
into
the
cul-‐de-‐sac
• Don’t
abort
vaginal
approach.
• If
you
cannot
enter
anteriorly
or
even
posteriorly
• Stay
within
the
uterus
and
at
some
point
• They
will
come
down
and
present
themselves
• And
then
go
ahead
and
go
in
• So
delay
entry
unRl
good
dissensus
and
visualizaRon.
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38.
AnaestheGc
Management
The
Key
Requirements
Minimal
postoperaRve
nausea
and
vomiRng
(PONV),
dizziness,
or
drowsiness,
Rapid
onset
and
offset
of
anaesthesia
with
clear-‐headed
emergence,
Rapid
return
to
full
cogniRve
funcRons.
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39. • Mobilize bladder
pillars superiorly
• Laterally
• Perform cystoscopy
• Present Inadvertent
• Occult kinking
of the ureters
• Bladder injury
PREPARE
• To Avoid Uretral injury
40. Surgical
factors
• Key
point
• One
day
surgery
needs
appropriate
surgical
experRse.
• The
procedure
should
not
have
significant
risk
of
major
postoperaRve
complicaRons
necessitaRng
immediate
medical
intervenRon
(haemorrhage,
cardiovascular
instability).
• No
prolonged
specialist
postoperaRve
care
or
observaRon
required.
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41. Surgical
factors
• PostoperaRve
pain
should
be
controllable
with
oral
analgesia
±regional
anaesthesia
techniques.
• PaRent
should
be
able
to
rapidly
resume
normal
funcRons
(oral
nutriRon,
safe
mobilizaRon).
DR
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42. PreoperaGve
preparaGon
• Successful
day
surgery
outcomes
require
good
preoperaRve
preparaRon.
• PreoperaRve
assessment
should
ideally
occur
as
close
to
the
decision
to
treat
as
possible
to
give
maximum
Rme
for
opRmizaRon
of
medical
condiRons,
hence
reducing
the
risk
of
cancellaRon.
• If
possible,
it
should
take
place
within
the
day-‐case
unit,
allowing
paRents
and
their
relaRves
to
become
accustomed
to
this
environment
and
staff
before
the
day
of
surgery.
• A
counselor
delivered,
consultant
supported
preoperaRve
assessment
service
is
the
most
common
model
with
protocols
for
invesRgaRons,
management
of
medicaRons,
and
other
issues.
DR
KAWITA
BAPAT
43. PreoperaGve
preparaGon
• This
has
three
essenRal
components.
1. EducaRon
of
paRents
and
carers
about
day
surgery
pathways.
2. Helping
paRents
to
make
informed
decisions
by
providing
verbal
and
wrifen
informaRon
regarding
planned
procedures
and
postoperaRve
care.
3. IdenRficaRon
of
any
medical
risk
factors
and
opRmizing
medical
condiRons
before
surgery.
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KAWITA
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44. • Thermal hemostasis
Need three steps
• Positioning of clamp
• Removal of clamp
• Cutting with scissors
• Classical
hemostasis
with
sutures
• Need
six
steps
• PosiRoning
of
the
clamp
• Severing
of
the
pedicle
using
scissors
• Placing
the
suture
with
needle
holder
• KnoXng
• Removal
of
forceps
• CuXng
of
the
suture
with
scissors
DR
KAWITA
BAPAT
45. • Burns • Thermal
necrosis
at the
ureter
• Thermal
wounds of
digestive
tract
• Bleeding
Immediate
Secondary
• Infection
PrevenRon
of
accidents
• 1 • 2 • 3 • 4 • 5
47. Vessel sealing
technology
• Ensures
reliable, Consistent
isolate vessels
• thermal spread predictable
• less energy delivery
• the pedicles are smaller and
therefore the steam effects are much
less lateral to the instrument
• . No Sticking and charring, reliable
seals
DR
KAWITA
BAPAT
52. Counter intuitive
hand movements
Unsteady
images and
big learning
curves
Insufficient
electrosurgical
tools
Technical limitations of Laparoscopic Surgeries
DR
KAWITA
BAPAT
53. MIVH
FAST
NO
CO2
LATEST
RELABLE
PAINLESS
SUTURELESS
CONVIENIENT
BLOOD
LESS
LESS
OT
TIME
COST
EFFECTIVE
EARLY
RECOVERY
LESS
RECOVERY
TIME
LESS
DURATION
OF
STAY
EXPERTISED
TECHNIQUE
WORLD
WIDE
ACCEPTANCE
INTERNATIONALLY
ACCLAIMED
LESS
DURATION
OF
ANAESTHESIA
NOT
GOING
THROUGH
SEVEN
LAYERS
OF
ABDOMEN
DR
KAWITA
BAPAT
56. DR
KAWITA
BAPAT
Sufficiently
advanced
technology
is
indisRnguishable
from
magic
Thankyou
57. • MS.FICOG
• DIRECTOR OF ONE CENTRE FOR
GYNAECOLOGICAL EXCELLENCE
• Senior practicing OBGYN at Indore
• ONE DAY HYSTERECTOMY SPECIALIST
• Chairperson female breast diseases
committee FOGSI
• Past president OBGYN Society INDORE
• GOVRNING COUNCIL MEMBER ICOG
• Past President LIONS Club INDORE
• TREASURER IMS INDORE Chapter
• Award winner of Nayika Indore and captain of
industry
• bapatkawita@gmail.com
• www.onegynae.com
• BAPAT HOSPITAL BAPAT CHORAHA SUKHLIA
INDORE
• +919826055666
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