Isolation and ligation of uterine arteries at its origin

[drsselva]

Thanks for your kind words

[iampropitiated]

Thank you for sharing your technique. In so doing, you have contributed to my own skills and improved the care I provide my patients.

[drsselva]

This technique is done to make sure that you have the uterine arteries tied up and ureters dissected out before continuing the surgery. This makes your surgery easier especially if you expect bleeding in difficult cases.

[S2ZeZoS2]

thanx 4 the video ... why this technique is done ?

[drsselva]

Besides the umbilical 10mm port for the laparoscope, I place 2 lateral ports. The location of these posts will depend on the side of the uterus. It can be as high as the level of the umbilicus or as low as the iliac fossa just later to the ASIS. I place a middle port midway between the symphisis pubis and the umbilicus. This is where I have my hook. I usually use a probe plus with suction irrigation and diathermy. settings 50w for coag and cutting.

[robinofgrimsby]

Dear Dr Selva

Thank you for sharing your excellent skills. What are your port placements and what is the setting of your monopolar hook?

All the best.

[robinofgrimsby]

Dr Selva

Thank you for sharing your excellent skills. What are your port placements and what is the setting of your monopolar hook?

All the best.

[drsselva]

You should be able to do both. Suturing of the ascending branch is easy. However if you have any bleeding near or around the ureter it is better to suture at its origin. I usually suture near the origin in difficult cases and suture the ascending branch in simple cases.

[TheHect33]

what is your preference.close to itsmo cervical o in origen uterine artery ligation.from lima peru. thanks .sorry my ingles. the video is excelent

[drsselva]

Sorry about that. This video was prepared several yrs ago when my video editing skills were not very good. I have decided not to include any music in my subsequent videos.

[drsselva]

Sorry about that. All my new videos will not have any music!!

[harisis80]

Very nice video BUT THE MUSIC TOTALLY SUCKS!!!! - Totally inapropriate

[drsselva]

It is always easy to remain in one's comfort zone by not dissecting out the ureters and the uterine arteries. It is not difficult and having performed over 700 cases using this technique, I can assure you I have never opened up a patient for a problem. I agree that in most of the cases it is unnecessary. It is better to aquire the skills in a simple TLH case than trying to do it in a difficult case such as severe endometriosis or when you have bleeding close the the ureter.

[TheKusumakumari]

Is it needed? I feel more dissection is more trouble more tissue damage I feel you are converting a minimally assesive surgery into very invassive procedure by ligating it at origin !!!

[Rayyan36]

Excellent!

[drsselva]

Thanks for your comments. Yes you need to be familiar with the pelvic side wall anatomy before you can perform this but it is not all that difficult. I will try to upload a video unedited, just on the pelvic side wall dissection and identifying of the uterine artery, in due time. In that video I will try to comment on all the difficulties involved in performing the procedure.

[mrajan999999]

thanks dr selva. its a very beautiful demonstration.i would like an unedited video(s) if you can provide me.i think your skill masks the inherent difficulty of a retro-peritoneal dissection though with practise it should be easy.there must be some tips which only experiences teaches.would you want to share those?

[drsselva]

Thanks for your comment. The trick is to practice, practice and practice.

Selva

Malaysia

[sumithra358]

Great vidoes indeed Liagting uterine A at its origin by laparoscopy! Wow thats great I find it difficult to do the same vene in poen surgeires You are a skilled and knowladgable suregon and individual

[highrollaplaya]

OMG!!! i cnt watch this omg omg i juz barf! oh idk how u doctors do it. omg idk why i cliked this

[apchaphekar]

I am convinced about the ureter being better visualized and all structures being clearly seen etc. BUT - to the best of my knowledge, the oblt. umbilical artery, when traced back, leads to the sup. vesical artery, not the uterine. Indeed, the 'uterine artery' that you have shown looks far too long and is seen getting dissected far too easily. Mebbe you are ligating the sup. vesical artery and not realizing it, since you go through the whole process of controlling the uterines at the isthmus.

[Sevellaraja]

I agree with you that the SVA is the first artery encountered when dissecting down the OUA. However it is essential to ensure that the artery crosses the ureter. The uterine arteries' origin can be very variable although it mostly originates from the OUA, it can come from other arteries as well. I have performed more than 400 case with this technique including laparoscopic radical hysterectomies with no problems. Please view my other videos for more information.

[neyhludov04]

Dr.Sselva, many thanks for your sharing this great surgical show.

I'm a resident and I havent seen hypogastric artery ligation, can you upload a video that clearly showing identification and ligation of hypogastric artery , please...

We, as residents would be grateful to you...

[Sevellaraja]

I do not have a video showing ligation of the hypogastric artery (Internal Iliac artery). There is no reason to do it except I believe if you are dealing with a bleeding postpartum uterus. I have not done such a case yet. However this artery is usually isolated during laparoscopic radical hysterectomy.

[mayisha22]

Is that heat you're using to seal off the tubes?? what's the worst possible injury that could occur??

[Sevellaraja]

The heat in this video is used to seal the arteries although we can seal the tubes as well. If one is not careful the heat can injure other important structures like the ureter, other blood vessels, intestines etc. Si it is essential to use good equipments

[drsselva]

Thanks for your comment. I agree that in a great majority of laparoscopic hysterectomies there is no need for retroperitoneal dissection. However, if one perform this technique routinely in every case, one can become confident in retropeitoneal dissection such that when a case requires such dissection, it will be easy. If the ureters are dissected out, any bleeding that can occur, can be controlled with a bipolar diathermy without any worry.

selva

[khashayarvosough]

Great technique. Have done almost 300 Laparoscopic hysterectomies. I usually reserve retroperitoneal disssection for the larger uteri. I use the harmonic scalpel, and often tie the uterine arteries before cutting them if they are prominent. Great great technique though. I am probably just going to do all of them via the retroperitoneal approach hence forth.

[Nancykmb77]

Thank you for replying. I would like to see the moment in which the utering itsmus to see how the vaginal cupule results in regards to the retroperitoneal disection you show.

Again, I think this is an excelent technique and I would like to learn more.

Cruces, MD

[sixtomd]

exelent tecnique i love it

[drsselva]

Thanks for your comment. Having performed about 800 laparoscopic hysterectomies, I find that by isolating and ligating the uterine arteries at its origin and dissecting out the ureters, I don't have to worry about unknown ureteric injury caused by diathermy.

selva

[benmachiche1]

Very very nice teaching, I'm also looking forward to learning from drsselva especialy the retroperitoneal anatomy. A. Benmachiche

[farukvan]

thank you for your great educational videos

[myobgyn]

Great retroperitoneal dissection!

looking forward to more from drselva

[drsselva]

Thanks for your comments. Hope to post more of my experience in performing laparoscopic surgery.