MINILAP HYSTERECTOMY

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MINILAP HYSTERECTOMY

• DR.ARATI PATNAIK
• PROF.SURENDRA NATH PANDA
• Dept. Of Obstetrics Gynaecology
• M.K.C.G.MEDICAL COLLEGE
• BERHAMPUR-760004, ORISSA, INDIA

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INTRODUCTION

• MINILAPAROTOMY is an established surgical
  technique long established for female
  sterilisation.
• The same concept is extended to abdominal
  hysterectomy for benign conditions in selected
  patients.

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PATIENT SELECTION

• Average built patient
• Mobile uterus less than 12 weeks size
• Cervix can be pushed above symphysis pubis
• Absence of large adenexal mass

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MATERIALS

• Period of study -
• Jan.99 to August, 2001
• Indication for hysterectomy
• DUB 73
• Fibroid 15
• Adenomyosis 11
• Dysplasia 13
• Postmenopausal Bleeding 06
• Total 118

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PROCEDURE

• Suprapubic transverse incision, 5-6 cm. Long
• No pack or retractor
• Uterus delivered outside
• With fingers or
• After fixing with Myomectomy screw / Volsellum or
  
• After Myomectomy

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PROCEDURE

• Hysterectomy with or without BSO done by standard
  procedure
• Vagina closed with one or two interrupted sutures
• Pelvic parietal Peritonium not closed
• Rectus sheath apposed with continuous suture
• Routine liberal use of diathermy

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MINILAP HYSTERECTOMY
The skin incision of 6cms length
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MINILAP HYSTERECTOMY
Uterus being delivered with a myomectomy screw
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MINILAP HYSTERECTOMY
Both sides infundibulopelvic ligaments have been
cut
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MINILAP HYSTERECTOMY
Both cardinal ligaments have been cut vault has
been reached
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MINILAP HYSTERECTOMY
Cervix seen through the anterior opening in the
vault
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MINILAP HYSTERECTOMY
Hysterectomy completed
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MINILAP HYSTERECTOMY
Skin incision is being closed
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MINILAP HYSTERECTOMY
Skin has been closed with two stitches
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PROCEDURE Contd.

• Suture material used - Vicryl no-1
• Routine liberal use of diathermy
• Skin closure
• Interrupted mattress sutures(2-3) with polyamide
  no 1, or
• Subcuticular stitch with vicryl rapide or
• Nectacryl gel

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PROCEDURE Contd.

• Antibiotic prophylaxis- CEFTRIAXONE
• 1 - 2 gm before induction of anaesthesia
  depending on body wt
• 1gm after 24 hours
• 1gm after 48 hours
• Operating time-
• 40 to 90 minutes, average 55 minutes

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POSTOPERATIVE PERIOD

• Catheter for 12 24 hours
• Iv fluids for 12 to 24 hours
• Analgesics as per need
• Oral feeding after 6-12 hours
• Full ambulation by 24 hours
• Stitch removal after 96 hours
• Fit for discharge on 4th day onwards

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COMPLICATIONS

• PYREXIA 6
• UTI 7
• AB WOUND INFECTION 4
• AB WOUND HAEMATOMA 1
• VAULT GRANULATION 2

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CONCLUSION

• Mini lap hysterectomy is an easy to learn
  minimally invasive surgical procedure.
• It has a shorter duration of surgery, faster
  recovery and reduced hospital stay.
• The morbidity is very less as general peritoneal
  insult is avoided.

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CONCLUSION

• Considering the cost benefit, safety and the
  results are comparable with LAVH / NDVH with
  less operating time , but does not require
  expensive equipment or high-TEC training.
• Considering the cost benefit and other
  advantages, it has a significant potential for
  use in developing counties particularly in rural
  hospitals.

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Thank you
Any Questions? Please Email-drsnpanda_at_hotmail.com