1. Laparoscopic Hysterectomy Conversion Risks into Laparotomy, Intra and Post- surgical complications Coordinators : Lect. M.D. PhD Nicolau C-tin. Romeo Dr. Costea N. Monica Author : Marin Argyriou Dimitris CoAuthors : Spirchez Ralisa, Rijnoveanu Iulia, Roxana Mihalcut Marisiensis 2014

2. Introduction Laparoscopy is a procedure that allows us to study the abdominal cavity using a cold light source Laparoscopy is a procedure that allows us to study the abdominal cavity using a cold light source Laparoscopic surgery is a procedure which allows us to study outside of the abdomen but also allows us the use of the microscopical instruments in abdominal cavity. Laparoscopic surgery is a procedure which allows us to study outside of the abdomen but also allows us the use of the microscopical instruments in abdominal cavity. Marisiensis 2014

3. Information Kurt Semm in 1984 in Germany described for the first time a technique for laparoscopic assistance in vaginal hysterectomy.The annexes were separated laparoscopically in order to simplify the vaginal hysterectomy. Kurt Semm in 1984 in Germany described for the first time a technique for laparoscopic assistance in vaginal hysterectomy.The annexes were separated laparoscopically in order to simplify the vaginal hysterectomy. Laparoscopically Assisted Vaginal Hysterectomy Laparoscopically Assisted Vaginal Hysterectomy The First Laparoscopic Hysterectomy was effectuated in Pennsylvania in 1988 by M.D. Harry Reich. The First Laparoscopic Hysterectomy was effectuated in Pennsylvania in 1988 by M.D. Harry Reich. Marisiensis 2014 M.D. Harry Reich Prof. Kurt Semm

4. LAPAROSCOPIC HYSTERECTOMY LAPAROSCOPIC HYSTERECTOMY CLASSICAL HYSTERECTOMY CLASSICAL HYSTERECTOMY Marisiensis 2014

5. Procedure The Proceduce consist in 5 steps. After the General Anesthesia is done: 1) CO2 will be intraabdominal injected, using the Veress needle 2) The telescop will be inserted through the Umbilicus 3) The other instruments are going to be introduced through another 3 incisions about 1cm diameter each Marisiensis 2014

6. Procedure 4) The Uterus will be separated and afterwards it will be fragmented by the Morcellator, or it can be extracted through vaginal way 5) Usually a drainage tube is being left in the Douglas sack in order to detect an eventual complication, such as a possible hemorrhage. Marisiensis 2014 Morcellator

7. Other Instruments Uterine-Manipulator Clermont Ferrand Laparocopic Ports- Scissors-Forceps- Camera Etc. Marisiensis 2014

8. Objective & Purpose The purpose of my paper is to show the efficiency of the laparoscopic procedure and the experience that more and more doctors are acquiring with the evolution of technology. The purpose of my paper is to show the efficiency of the laparoscopic procedure and the experience that more and more doctors are acquiring with the evolution of technology. Marisiensis 2014

9. Material Method Our study has been done on 74 women, aged 31- 83 years old from Obstetrics-Gynecology Clinic No I from Tg.Mures. Our study has been done on 74 women, aged 31- 83 years old from Obstetrics-Gynecology Clinic No I from Tg.Mures. 2006 – 2014 2006 – 2014 Marisiensis 2014

10. Indications The Laparoscopical Hysterecomy in our study has been applied in the following cases :  Endometriosis – Fibroms  H-SiL & CIN Stg 2-3  Endometrial Tissular Overgrowth (Hyperplasia)  Uterin Cancer & Adenocarcinoma Std IA  Infections and Cysts upon Ovarian tubes  Several Vaginal Prolapse  Hemorrhagic Metropatia  Cystorectocel with urinary retention Marisiensis 2014

11. Results 16 = 21,6%18 = 24,4 %40 = 54% Marisiensis 2014

12. Intraoperative Risks It can be many such as :  Damage of the Bladder, Ureters, Bowel and Annexes  Vessel Damage (Aorta, Inf Vena cava, Uterine artery)  Bladder continuity solution  Cardiac Arrhythmia due to Anesthesia  Subcutaneous Emphysema  Gas Embolism  Hypercapnia Marisiensis 2014

13. Results

14. Results * 38 cases required Bilateral Annexectomy. * 19 cases required anterior Colporrhaphy, and 17 of them necessitated Colpoperineoplasties. * To 43 patients, a drainage tube was introduced in Douglas Sack for a better efficient control of the Hemostastys. Marisiensis 2014

15. Postoperative risks It didn't exist any early postoperatory complications in our study but also it could be :  Blood clot in the Legs or Lungs ( Trombosis, Pulmonary embolia)  Vaginal Prolaps  Infection, Inflamatio  Incisions Opens  Vulvar Edema  Nerve Injury due to Anesthesia Marisiensis 2014

16. Results The main time of Hospitalisation was 3-4 days for Laparoscopical interventions and 5-7 days for the ones Converted into Laparotomy Marisiensis 2014

17. Conclusions The Laparoscopic Assisted Vaginal Hysterectomy is recommended also when genital prolaps occurs. The Laparoscopic Assisted Vaginal Hysterectomy is recommended also when genital prolaps occurs. The Laparoscopic Hysterectomy has lower costs because the hospitalisation is shorter, it is minimally invasive and it can be efficient as the classical technique, also it distinguish that the reason of conversion weren't iatrogenic errors. The Laparoscopic Hysterectomy has lower costs because the hospitalisation is shorter, it is minimally invasive and it can be efficient as the classical technique, also it distinguish that the reason of conversion weren't iatrogenic errors. Marisiensis 2014

18. Conclusions The Laparoscopic Hysterectomy represents a feasible technique and it should be applied on every patient in the departments that are having Laparoscopic Instruments, but before applying this technique we need a good evaluation of each patient. The Laparoscopic Hysterectomy represents a feasible technique and it should be applied on every patient in the departments that are having Laparoscopic Instruments, but before applying this technique we need a good evaluation of each patient. The gynecologist surgeon also should be aware of the possible difficulties that may appear during the surgery, and he should inform the patient about a possible conversion into Laparotomy The gynecologist surgeon also should be aware of the possible difficulties that may appear during the surgery, and he should inform the patient about a possible conversion into Laparotomy Marisiensis 2014

19. References * Sutton C. Hysterectomy: a historical perspective. Baillieres Clin Obstet Gynaecol 1997; 11:1-22. * Sutton C. Past, Present and Future of Hysterectomy. J Minim Invasive Gynecol 2010; 17(4):421-35. * The Regents of the University of Michigan Author: Laurie, Crimando RNC,MSN Reviewers: K., Wang, MD Last Revised 12/2010 * WebSite GOOGLE * Williams Obstetrics 23 rd Edition Copyright © 2010 Marisiensis 2014

20. THANK YOU Marisiensis 2014