It refers to complete hysterectomy under laparoscopic surgery, the uterus is removed from the vagina or not from the vagina, and the vaginal stump is closed by laparoscopy. That is, the whole process of hysterectomy is completed under laparoscopy. At present, laparoscopic hysterectomy can not completely replace transabdominal hysterectomy and vaginal hysterectomy, which is a minimally invasive surgery that may cause most patients with hysterectomy to avoid laparotomy.
a. a. The patient takes the bladder lithotomy position, guides the catheter, and puts it into the uterus.
b.5mm10mm b. 5mm, 10mm puncture holes on both sides of the umbilicus and abdominal wall.
c.() c. Treatment of uterine round ligament and fallopian tube, ovarian intrinsic ligament (cut the pelvic funnel ligament without retaining the ovary).
d. d. Open the anterior and posterior lobe of the broad ligament and the peritoneal reflex of the bladder, and push down the bladder.
e. e. Treatment of uterine blood vessels:
Methods for cutting off uterine blood vessels are:
Titanium clip method: The uterine artery must be separated before applying the titanium clip. The near-pelvic wall side is close to the upper two titanium nails, a titanium nail on the uterine side, and then the uterine artery is cut.
() Cutting stapler method: The cutting stapler is performed along the uterus. When the tissue to be cut is inside the forceps, the stapler is cut tightly (also used for attachment removal).
2/0 Sewing method: use 2/0 absorbable line, ordinary needle or laparoscope special sled needle to sew through the uterine blood vessels in the uterine isthmus, and knot in the cavity or outside the cavity.
Ultrasonic scalpel application method: the uterine blood vessels are clamped with ultrasonic scissors, and the heat generated by ultrasonic vibration is used to coagulate the tissue protein and then cut off. 5mm The ultrasonic scalpel can condense blood vessels of 5 mm. Ultrasonic scalpels can be used throughout the procedure.
f. f. Cut the main ligament and treat it with electrocoagulation or ultrasonic scalpel.
g. g. Cut the uterus from the anterior and posterior wall of the vagina, remove the uterus from the vagina, put the uterus into the vaginal dome, and top the pelvic cavity. The surgeon cuts the vaginal wall along the dome by electrocoagulation.
h. h. After clogging in the vagina, re-inflate the abdominal cavity and suture the vaginal wall under the microscope.
i. i. Flush the pelvic hemostasis to close the puncture hole.