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Total Laparoscopic Hysterectomy + Vault Suspension Using Round Ligament + Retrocecal Appendectomy скачать в хорошем качестве

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Total Laparoscopic Hysterectomy + Vault Suspension Using Round Ligament + Retrocecal Appendectomy

Total Laparoscopic Hysterectomy (TLH) is a minimally invasive procedure that has become the standard for many gynecological conditions requiring uterine removal. The technique allows for less postoperative pain, shorter hospital stays, and quicker recovery times compared to open hysterectomy. A critical aspect of TLH is ensuring proper vaginal vault suspension to prevent post-hysterectomy vaginal vault prolapse. In this article, we discuss TLH with vault suspension using the round ligament as an anchor point. Additionally, we explore the management of a retrocecal appendix in patients undergoing TLH, highlighting the surgical considerations for performing an appendectomy in such cases. In many instances, TLH is combined with vault suspension to prevent post-hysterectomy prolapse, especially in patients with pre-existing pelvic floor weakness or significant pelvic organ prolapse. TLH with Vault Suspension Vault suspension following TLH is essential to prevent future prolapse of the vaginal cuff, which can occur due to the loss of uterine support. Several ligaments and techniques can be employed for vault suspension, and in this article, we focus on using the round ligament for this purpose. The uterus is mobilized by ligating and dividing the ovarian and round ligaments using energy devices such as the Harmonic Scalpel. This ensures precise cutting with minimal thermal spread, reducing collateral damage to surrounding tissues. The uterine arteries are also sealed and divided at their origins using the Ligasure, ensuring secure hemostasis. The uterus is then separated from the cervix, and the vaginal cuff is opened to allow for removal of the uterus through the vagina. 3. Vault Suspension Using the Round Ligament: Following removal of the uterus, the vaginal cuff is sutured using delayed absorbable sutures. The round ligament, which is typically divided during the procedure, is then utilized to suspend the vaginal cuff. This is done by suturing the remnant of the round ligament to the vaginal vault. Using this ligament provides additional support, preventing future vault prolapse. Depending on patient anatomy, the uterosacral ligaments may also be incorporated for additional support. Retrocecal Appendectomy During TLH In some cases, especially when performing TLH for endometriosis or pelvic pain, the surgeon may encounter a diseased appendix. A retrocecal appendix, where the appendix is hidden behind the cecum, presents additional challenges due to its atypical location and proximity to the retroperitoneum. Surgical Considerations for Retrocecal Appendectomy Once the appendix is identified, it is mobilized using the Harmonic Scalpel. This device allows for precise dissection and division of mesoappendix and appendix while ensuring adequate hemostasis. The appendix is then divided at its base using a linear stapler or by ligating it with absorbable sutures, depending on surgeon preference. 3. Postoperative Considerations: Patients undergoing appendectomy during TLH do not typically require additional recovery time compared to patients undergoing TLH alone. However, care must be taken to monitor for any signs of infection or postoperative complications, especially in cases of acute appendicitis or perforation. Postoperative Care Following TLH with vault suspension and appendectomy, patients are typically managed with: Early ambulation and deep breathing exercises to prevent venous thromboembolism and atelectasis. Adequate pain control, often utilizing non-opioid medications to minimize narcotic use. Monitoring for signs of infection or bleeding at both the vaginal cuff and appendectomy sites. Patients are usually discharged within 24–48 hours and can resume normal activities within 2–4 weeks, depending on their overall health and recovery speed. Conclusion TLH with vault suspension using the round ligament provides a reliable technique for preventing post-hysterectomy vaginal vault prolapse, particularly in patients at higher risk of pelvic floor dysfunction. Simultaneous retrocecal appendectomy can be efficiently managed using laparoscopic techniques when indicated, ensuring comprehensive care for patients with coexisting pelvic and appendiceal pathology. This combined approach not only enhances patient outcomes but also highlights the versatility and effectiveness of laparoscopic surgery in addressing multiple intra-abdominal pathologies in a single session. Surgeons must remain vigilant in identifying anatomical variations and adjust their surgical approach accordingly to optimize results. Contact us World Laparoscopy Hospital Cyber City, Gurugram NCR Delhi, India World Laparoscopy Training Institute Bld.No: 27, DHCC, Dubai, UAE World Laparoscopy Training Institute 5401 S Kirkman Rd Suite 340 Orlando, FL 32819, USA

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