Simplified Laparoscopic Hysterectomy: Practical, Safe and Economic Methodology Rajendra S Sankpal, Mahantesh Karoshi, Late Louis G Keith
Page numbers followed by f refer to figure
Abdomen 37
Abdominal wall 11
anterior 8
preparation 37
Abscess, intra-abdominal 8
Accessory instrument trolley 23f
Adhesions 8
intra-abdominal 8
Adnexae 40
Allen type stirrups 18
general 33
hypotensive 54
Aorta, bifurcation of 17f
Atrophic uterus 7
Atrophy 28
Bipolar forceps 29, 30
tip of 22
adequate dissection of 6
catheter 9
dissection 26, 27, 48, 49
distended 38
Blood pressure 54, 60
Body mass index 7
Bowel 8
adhesions 8
Carbon dioxide insufflation 7
Cardiac disease 33
Cardiorespiratory system 8
Cervical dilatation 37
Cervico-vaginal junction 27
Cesarean sections 8
Colpotomy 51
incision, posterior 51
Cornual structures
coagulation of 45, 48
cutting of 45, 48
Deep vein thrombosis 14, 18
Diabetes 33, 61
Endometriosis 7, 8, 25
Endovision cart 30
Fluid, abdominal 52
Foley catheter 24, 37
Foley inflation 24f
Hemostasis 46
Hypertension 33
Hypotension 60
Hypothermia 18, 31
Hysterectomy 53
abdominal 47, 50
intrafascial technique of 49
Instrument trolley 28
Instrumentation 24
Insufflator 32f
Intestinal surgery 8
Intravenous cannula 9
Laparoscope 29, 39, 40
hysterectomy 47, 16, 20, 25, 30, 61
instrument trolley 11, 21f, 28, 29
power morcellators 53
scissors 29
surgery 4
surgical skills 30
suturing 29
uterine power morcellation 53
Laparotomy 7, 9
gynecological 39
history of 8
multiple 8
Ligament, cauterization of 6
Mackenrodt ligaments 50
Main instrument trolley 23f
Manipulator for bladder dissection, rotating movement of 26
Myoma 52
screw 25, 29, 51, 52
Myomata 8
Myomectomy 8, 53
Nasogastric tube 38
Needle holder 29
Nonsteroidal anti-inflammatory drug, intravenous administration of 60
Obesity 33
Open laparotomy 41
Operating table, fulcrum of 14
Operation room set up 21f
Ovarian pedicle 45
Pain, postoperative 60
discomfort 61
inflammatory disease 5, 25
pathologies, combination of 33
Peritoneal dissection, posterior 48
Pneumoperitoneum 33
Polyglactin suture number 1 29
Port insertions 39
Posterior parametrium, dissection of 50
Posterior peritoneum, dissection of 47
Posthysterectomy 8
Postoperative care 59
Pouch of Douglas 8, 40
Previous cesarean delivery, history of 8
Pubic symphysis 37
Renal system 8
Samson's artery 46, 47
Sankpal's modified uterine manipulator 2426, 41, 42
Sankpal's uterine manipulator 24, 26, 37
Scar 38
abdominal 8
Sequential calf muscle compressors 18
Skin antisepsis 37
Stomach distension 38
Superior iliac spine, anterior 37
Surgeon's umbilicus 11
Surgical disease 8
Table, fulcrum of 12f
Ten operative steps 45
ergonomics 20
set up 11
table 11, 12, 14
Thyroid disorder 33
Tooth grasper forceps 29
Total laparoscopic hysterectomy 4, 7, 25, 26, 41, 42, 45
stepwise description of 45
Trendelenburg position 8, 16
premature induction of 16
Trocars 29
Umbilicus 37
Ureter anatomy of 5, 5f
dissection 6
injury 6
Uteri, normal 7
arteries 24
cavity 26
fundus 6, 48
height 38
manipulation 27
manipulator 24, 25
morcellation 25, 52
pedicle 47
skeletonization of 48
scar 8
coagulation of 49
skeletonization of 27, 47
Uterocervical length 26
Uterosacral ligaments 50, 51
Uterovesical peritoneal fold, dissection of 46, 47
Uterus 8, 39, 41, 52
rotation of 25
assistant 21f, 41
monitor for 21f
bleeding, postoperative 61
closure 54
delineator tube 24, 28
instrument trolley 11, 21f, 24
vault 61
closure of 53
epithelialization of 61
Varicose veins 33
Veress needle 31, 38
World Health Organization 13
Xyphisternum 37
Chapter Notes

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1Preparing to Operate
Section Outline
  • • Introduction
  • • Anatomy of Ureter
  • • Patient Selection
  • • Patient Preparation
  • • Theater Set Up
  • • Theater Table
  • • Patient Positioning
  • • Theater Ergonomics
  • • Instrumentation
  • • Anesthetic Considerations2

IntroductionCHAPTER 1

Health professionals frequently believe that advanced laparoscopic surgeries are generally only accessible to patients in developed countries. They also are of the opinion that laparoscopic equipment is costly and that to master advanced techniques, one has to attend expensive training sessions. The authors, on the other hand, firmly believe that these opinions are not true and in this volume have set forth to show how and why things are really different.
This publication shows or proposes new laparoscopic techniques; moreover, it shows how to perform laparoscopy and, in particular laparoscopic hysterectomy, more simply, more easily and at less expense. We are not writing about cheap instruments, but about the elimination of the clutter that has accumulated over the years and has contributed to the generally held impression that advanced techniques are extremely costly, laborious and labor intensive.
Having said this, it is important for the reader to realize that mastering the technique of laparoscopic hysterectomy requires diligence, dedication and developing a team of assistants to guarantee that all is ready and workable when it is needed. Time wasted looking for instruments that are ‘down the hall’ is to no one's advantage and, in the long run, costs money. The number of instruments that are required for laparoscopic hysterectomy is not great, but they must be present and in working order before the patient enters the theater.
The ‘evidence’ behind the rationale we propose is based upon the personal operative experience of Dr Rajendra Sankpal, one of the leading Laparoscopists of India. He began his laparoscopic practice after completing the FIGO Fellowship in Chicago, USA. During this Fellowship, he worked under Dr Charles Koh, the late Dr Harry Hasson, Dr Andrew Brill and other leading American Laparoscopic Surgeons. Prior to undertaking this training, he had the opportunity to work under Professor Arnold Wattiez of France. By working with these great personalities, he not only absorbed their unique skills, but also began to think about simplifying the complicated aspects of advanced 4laparoscopic surgery in order to take it back to his home in India. Through this book we attempt to introduce all those tricks and tips to make laparoscopic hysterectomy simple.
Our final aim is to prepare an average gynecologist who has had experience with simpler forms of laparoscopy, and perhaps some experience at what may be defined as advanced work, to develop more extensive skills with an idea of advancing to perform laparoscopic hysterectomy with safety in mind.
If our aim is achieved, it will help physicians to contribute to their country's prosperity, as more women spend less time in the hospital, recover faster and look after the family or start working once more in the field, in the office or at home.
This book presents a series of steps which must be mastered individually. By approaching the operation in this manner, one reduces the time taken to master the learning curve necessary to perform a complete laparoscopic hysterectomy. By understanding good instrumentation techniques, for example, the known complications of laparoscopic hysterectomy will be avoided. The authors demonstrate how, by correctly using minimal instruments, one can perform total laparoscopic hysterectomy (TLH).
This book illustrates how one can be cost effective and use a minimum number of ports. It also demonstrates the steps of TLH which are universal for all cases and for numerous varieties of uteri. The steps of TLH described in this book are easily reproducible if the reader carefully follows all of them, including those presented and discussed in the videos. The final intent of the authors is that the reader should be able to master safe surgical technique of TLH in a cost effective and reproducible manner.