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Enhancing Hysterectomy Surgery: TLH and BSO with ICG Guidance - A Step-by-Step Tutorial
Hysterectomy, one of the most common surgical procedures performed in gynecology, has evolved significantly over the years. Total Laparoscopic Hysterectomy (TLH) and Bilateral Salpingo-Oophorectomy (BSO) represent advanced approaches in this field. The integration of Indocyanine Green (ICG) fluorescence imaging has further revolutionized these procedures, offering enhanced visualization and increased safety.
1. Introduction to TLH and BSO
TLH involves the removal of the uterus laparoscopically, offering a minimally invasive option compared to traditional surgery. BSO, the removal of both ovaries and fallopian tubes, is often performed concurrently. These procedures are indicated in various conditions, including uterine fibroids, endometriosis, and ovarian cancer.
2. The Role of ICG in Enhancing Visualization
Indocyanine Green, a fluorescent dye used in medical imaging, becomes visible under near-infrared light. When injected intravenously, ICG binds to plasma proteins and stays within the vascular system, allowing surgeons to visualize blood flow and tissue perfusion. In the context of TLH and BSO, ICG aids in identifying key structures such as blood vessels, ureters, and the boundaries of tumors.
3. Preoperative Considerations
Prior to surgery, patient selection and counseling are crucial. Not every patient is a suitable candidate for TLH and BSO using ICG. The benefits, risks, and alternatives should be thoroughly discussed. Preoperative imaging and preparation, including bowel preparation, are also necessary to ensure optimal surgical conditions.
4. The Surgical Procedure: A Step-by-Step Guide
- Step 1: Anesthesia and Positioning - The patient is placed under general anesthesia and positioned to allow optimal access to the pelvic region.
- Step 2: Trocar Placement and Abdominal Insufflation - Small incisions are made for trocar placement, and the abdomen is insufflated with gas to create a working space.
- Step 3: ICG Injection - After initial inspection of the pelvic cavity, ICG is administered in both the ureter.
- Step 4: Identification of Structures - Using a near-infrared camera, the surgeon identifies vascular structures, ensuring precise dissection and minimizing the risk of bleeding.
- Step 5: Uterine Manipulation - Specialized instruments are used to manipulate the uterus, providing better access for dissection.
- Step 6: Dissection and Removal - The uterus, and if indicated, the ovaries and fallopian tubes, are carefully dissected and removed.
- Step 7: Hemostasis and Closure - Ensuring there is no bleeding, the incisions are closed.
5. Postoperative Care and Recovery
Postoperative care includes pain management, monitoring for complications, and early mobilization. Recovery time varies, but most patients experience less pain and a quicker return to normal activities compared to traditional surgery.
6. Benefits and Limitations
The use of ICG in TLH and BSO offers enhanced safety and precision. However, it requires specific equipment and expertise. The cost and availability of such technology may limit its widespread use.
7. Conclusion
The integration of ICG in TLH and BSO procedures represents a significant advancement in gynecological surgery. This approach enhances the safety and efficacy of the surgery, promoting better outcomes for patients. As technology advances, such techniques are expected to become more accessible, further revolutionizing surgical care.
This article serves as a basic guide and should be supplemented with thorough training and adherence to updated clinical guidelines for practicing surgeons.
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
