1.Concept of minimally invasive surgery – classic example like laparoscopic cholecystectomy.
2.Laparoscopic Hysterectomy introduced in 90’s
3.Advantages of Laparoscopic Hysterectomy
4.Majority of Gynaecologists / patients – rural / semi urban areas – NOT able to afford the cost
5.Benefits of laparoscopic surgery minus increased cost, complications & instrumentation.

Purpose
To reduce
  post-operative pain
  tissue destruction & edema
  morbidity
  intra-operative blood loss
Improved  early  mobility
Reduced hospital stay
Cosmetic scar

Method
Around 4-5 Cm(1.5 ” To 2 ”) Mini-pfannestiel  Incision - Taken  In  Pubic Hair-line
  Obliquely Pulling, Left Cornu  Delivered
  Uterus Turned To Left & By Pull, Right Cornu Delivered Out
  “obliquely Pull-turn-pull-push Action ”
  Uterus & Adnexae Delivered Out Of Abdomen
  Use Of Small C-shaped & Right Angled Retractors , Instead Of Self Retaining Ones.
  Rest Steps Of Hysterectomy Same As In Routine - Vaginal Closure, Peritonization .
  Largest Removed Uterus -  4” In Breadth

Advantages
 Cosmetic Value
 Reduced Bleeding , Tissue Damage , Edema
 Less  Pain -  Painless Hysterectomy
 No Intestinal Handling
 No Bladder Drainage
 Early Mobility - No Dvt
 Early Discharge
 Early  Resumption Of Daily Core

Disadvantages
 Not  Possible In  -
    Large Fibroids , Large Solid Ovarian Masses
    Grossly Obese Patients (upto 100 Kg Patients Have Beeen Operated)
    Malignancies
    Multiple Abdominal Surgeries (many Previous 2-3 Lscs Patients Have Been Operated)
 Delivering Uterus Out Difficult - Needs Skill, Maneuverability And Practice .
 Restricted Visibility.

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