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Surgical Pearls (Beads) Mark K. Dodson, M.D. Professor Department of OB/Gyn Division of Gynecologic Oncology University of Utah
I have no financial interests to disclose.
Controlling Pelvic Bleeding Developing Pelvic Spaces to Identify Blood Supply Packing Increase Abdominal Pressure
Pelvic Spaces and Boundaries Paravesicle Space Medial:Obliterated Umbilical A. Lateral: External Iliac V. Inferior: Bladder Superior:Cardinal Ligament Pararectal Space Medial: Ureter Lateral:Iliac Vessels Inferior:Cardinal Ligament Superior:Sacrum
Management of Intraoperative Hemorrhage PRESSURE
Intraoperative Control of Oozing During Laparoscopy Increase Abdominal Pressure to 20 mmHg Normal: 5 - 7 mmHg Morbid Obesity: 9 - 14 mmHg Intraabdominal Hypertension: > 15 mmHg Abdominal Compartment Syndrome: > 25 mmHg Transient Increases Appear to be Safe
Refractory Intraoperative Hemorrhage Pelvic Pressure Pack Sterile Plastic Bag Laparotomy Towels IV Tubing Container of Fluid
Pelvic Pressure Pack
Pelvic Pressure Pack 11 Patients Life Threatening Hemorrhage 10 Obstetrics, 1 Gynecologic 9/11 Successful (82 %) Post-Op Fevers (Antibiotics) Dildy et al Obstet Gynecol 2006
Berci Fascial Closure Device Closing Laparoscopic Port Site Controlling Abdominal Wall Bleeding
Berci Fascial Closure Device
Cost of Fascial Closure Endo Close$35 - $50 Berci$1090
Ureterolysis Enter Retroperitoneum Develop Pararectal Space Identify Ureter at Medial Leaf of Broad Ligament (At Common Iliac Artery) Dissect Free From Medial Leaf Dissect Parallel Along Ureter
Removing CO 2 From Abdominal Cavity To Assess for Bleeding at Low Pressure Decrease Postoperative Shoulder/Upper Abdominal Pain and Nausea/Vomiting
Reducing Laparoscopic-Induced Shoulder and Abdominal Pain RCT (116 Patients) Passive Deflation thru Cannula Trendelenberg Position (30°) Pulmonary Recruitment Maneuver 5 Manual Inflations of Lungs Significant Improvement in Shoulder/Upper Abdominal Pain, Nausea/Vomiting (>1/2) Phelps, et al. Obstet & Gynecol, May 2008
Placement of Adhesive Sponge for Anti-Fog Place in Most Efficient Site Possible
Dimpling at Laparoscopic Port Site When Superficial SubQ Tissue is Tethered to Fascia Even Heavy Women Do Not Like Dimples Undermine with Index Finger
Closing Fascia with No Tension at Knot Weakest Site of Suture is the Knot Corners of Incision Have Least Tension Prevents Direct Tension at Knot
Difficult Dissection at Level of Bladder Fill Bladder with Fluid to Evaluate Contour Allow Foley to Curl in Bladder Tape Foley to Leg to Prevent Tension Use 10cc of Fluid at Bulb
Total Laparoscopic Hysterectomy
Retroperitoneal surgery 2 By Dr. Khattab Omar, MD Prof. & Head of Obstetrics and Gynaecology Department Faculty of Medicine, Al-Azhar University, Damietta.
Uterosacral Suspension. Educational Objectives This lecture will enable the participant to list and discuss the indications and complications of uterosacral.
Pelvic Anatomy from a Laparoscopic Perspective Tommaso Falcone MD Professor & Chairman Cleveland Clinic Foundation.
Medical and Surgical Procedures While in the NASG ©Suellen Miller 2013.
Robotic Assisted Laparoscopic Pyeloplasty Dr J. Hagerty Pediatric Urology
Avascular Spaces of the Pelvis
Vaginal Hysterectomy: Modified Safe Technique Professor Galal Lotfi, MD, MRCOG Obstetrics & Gynecology Suez Canal University Egypt.
Dr alibakhshi general&cancer surgeon. HEMATOMA AND SEROMA Treatment — Small hematomas and seromas can be managed expectantly, while large collections.
Brielle Bowyer & Preston Paynter
Retroperitoneal surgery 3
Hernias Dr. Saleh M. Aldaqal MBBS, FRCSI,SBGS
Treatment Both primary lesion and potential sites of spread should be treated Surgery, radiotherapy, chemoradiation Radiation therapy can be used in all.
Complications of laparoscopic surgery Fereshteh Daneshmand M.D.
Safe Laparoscopic Access: technologies and techniques
SAFE ENTRY IN LAPAROSCOPY
SurgerySurgery Abdominal Wall Reconstruction: Patch the tire or rebuild the car? Michael J. Rosen MD, FACS Associate Professor of Surgery Chief, Division.
Specialists Without Borders
Diagnostic Laparoscopy Alexander Parata. Diagnostic Laparoscopy - a procedure that allows a health care provider to look directly at the contents of a.
Laparoscopic Hysterectomy: Total, supracervical, robotic, single port ? Tommaso Falcone, M.D. Professor an Chair.
Royal Free Hospital, London Endoscopic Surgery: Risk Management and Medico-Legal issues.
By elham rabiee Abdominal compartment syndrome refers to organ dysfunction caused by intraabdominal hypertension. Intraabdominal hypertension (IAH)
Laparoscopic Adrenalectomy Wahjoe Djatisoesanto Michel Gagner.
3-Patient Positioning the etiology of position-related neuropathy is generally secondary to excessive stretch, prolonged compression, or ischemia. The.
INGUINAL HERNIA REPAIR: OPEN vs TEP APPROACHES
Laparoscopic Hysterectomy Conversion Risks into Laparotomy, Intra and Post- surgical complications Coordinators : Lect. M.D. PhD Nicolau C-tin. Romeo Dr.
Ectopic pregnancy: Definition: Any pregnancy accruing outside the uterine cavity incidence 1/100 one cause of maternal death.
ROBOTIC MYOMECTOMY Dr Rooma Sinha, MD, DNB
Dr. Ibrahim Bashayreh RN, PhD
URINARY BLADDER & PELVIC PART OF URETERS Dr. Ahmed Fathalla Ibrahim.
CONTRAINDICATIONS TO LAPAROSCOPIC NEPHRECTOMY. Dr. Anmar Nassir, FRCS(C) Fellowship in Andrology (U of Ottawa) Fellowship in EndoUrology and Laparoscopy.
Compartment Syndrome Kyle Miller. Compartment Syndrome Definition Definition Compartment Syndrome involves the compression of nerves and blood vessels.
Tough Situations In Ventral Hernia Repair: A Community Perspective
Dr. Mohamed Ahmad Taha Mousa Assistant Professor of Anatomy and Embryology.
Dr. Mohamed Ahmad Taha Mousa
AVOIDING COMPLICATIONS IN ENDOMETRIOSIS SURGERY Danie Botha FEMBRYO Fertility and Gynaecology Clinic Port Elizabeth UCT Postgraduate Refresher Course 2015.
Laparoscopic Placement of the BardPort Intraperitoneal Catheter and Reservoir Dr. Arlan F. Fuller, Jr. Gillette Center for Women's Oncology Massachusetts.
Abdominal hernia Different types of abdominal external hernias Anatomy
Operating Room Supplies Terminal Objective: List supplies used for a specified operative procedure.
Radical Laparoscopic Prostatectomy: Managing Localized Prostate Cancer Chase Wilson M1.
林必盛 中國醫藥大學 麻醉部. Indications The Fascia Iliaca Compartment Block (FICB) is a simple block for post-operative pain relief for procedures and injuries involving.
Study Pics for Cat Dissection Test Use the list you have for your choices – there are more choices on these photos than you have to know. Go to some of.
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