Hystérectomie vaginale et sans douleur
Painless vaginal hysterectomy with thermal haemostasis and multimodal anesthesia : The new paradigm for Hysterectomy ?
Study objective : To report an innovative surgical procedure for vaginal hysterectomy to fight pains and obtain a fast post-operative recovery.
Design : The classical technic of vaginal hysterectomy is simplified using thermal haemostasis with ERBE Bi-Clamp® and multimodal anesthesia.
Setting: Clinique St George Nice (France)
Patients: Between march 2002 and july 2004, 152 patients presenting with benign lesions had been operated based on this innovative surgical technique.
Interventions: This video describe with precisions each steps of the technique, and detailed the specific issues allowing a very low rate of adverse events. The multimodal anesthetic procedure is detailed to avoid nociceptive effects. The haemostasis with high-frequency current and modulated impulses depending of the impedance is made with the ERBE Bi-Clamp®. This tool with easy handling makes easier and faster difficult haemostasis particularly through narrow vagina or for infundibulo-pelvic ligaments. The branches are covered with a wide and smooth steel surface which reduce sticking effect and thereby the risk of carbonisation. There were only 2 instruments in the vagina: The Pozzi forceps for the positioning of the treated area, and alternately the Bi-Clamp® or the scissors. The Bi-Clamp® should always carried out as close as possible to the middle of the vaginal shaft at the edge of the uterus.
Results: No serious immediate or secondary bleeding, no thermal trauma to the ureter or to the intestines was noted and no fistula developed. One randomized sub-group demonstrated a substantial reduction of pain. For the last 50 patients a standard hospital stay of one day was possible in 86% of cases. Conclusion: This easier and faster innovative procedure for vaginal hysterectomy expand the range of vaginal indications while shortening the patient’s stay to one day.