Nowadays newly developed medical devices make hysterectomy possible by a laparoscopic intervention. The advantage for the patient of the laparoscopic method is less pain and a much faster recovery. Patients appreciate much the minimal invasive character of this operation because it leaves almost no scars on the patient’s skin, reduces the healing of the wounds and safes money and time for all involved parties.
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Accessories and Spare Parts
A manipulator (guide instrument) is inserted into the uterus via the vagina to enable it to be moved during the operation. A ceramic cap over the cervix later allows it to be safely withdrawn from the vagina. The abdominal cavity is filled with gas (CO2) through a thin cannula in order to elevate the abdominal wall and provide an unobstructed view of the abdominal organs. The camera optics is inserted in the umbilical area through a percutaneous access route. The required surgical instruments (e.g. electric scissors, morcellator, haemostatic clamps, etc.) are inserted in the lower abdomen through small (5 – 10 mm) incisions. The camera passes the image to a large monitor. The modern optics and instruments provide an unobstructed view and so ensure safe surgery.
If the uterus requires complete removal (up to the outer cervix), the incision is made at the ceramic cap and then it is sutured. The severed uterus is excised from the abdominal cavity piece by piece with the morcellator and aspirated. In the case of a supracervical hysterectomy the uterus is severed above the inner cervix. Depending upon the diagnostic findings the physician opts either to remove the uterus through the vagina or by laparoscopic means. In the event of a higher risk, for example, due to an enlarged uterus and thus reduced visibility and constricted space, the surgery can be concluded by means of an abdominal incision. The uterus can, however, invariably be removed using morcellation in all the variants on a hysterectomy.
Morcellation with Protection Sleeve
At the Hysterectomy in laparoscopic surgery the Morcellator is inserted into the abdominal cavity with the Obturator inserted in the Protection Sleeve. After removing the Obturator, the Cutting Tube can be inserted. To expose the Cutting Tube to the tissue that has to be removed, the Protection Sleeve has to be unlocked from the Non-cut position by holding the Transmission Unit with one hand and performing a counter movement of the Protection Sleeve with the other hand.
Morcellation with Trocar Sleeve
When morcellating with a Trocar Sleeve the abdominal wall is kept in save distance from the operation area by inflating the abdominal cavity. This gives also safe clearance for the surgical operation. The Trocar Sleeve stays flexible while operating, means it can be rotated against the organ or tissue to be protected. Only than the Obturator is removed and the Cutting Tube can be inserted. The configuration of instruments needed for this procedure are shown on the System chart under option 2. Under option 1 the configuration with the Cutting Tube is shown.