00:00hello friends this is a case of da vinci robotic hystectomy this patient is suffering from dub and
00:08we will perform robotic hystectomy she is a 45 year old ladies with a severe dub and several
00:16treatment of the medical treatment is failed so we will perform the robotic hystectomy and here
00:23we will use forearm da vinci hd robot and first i will demonstrate you a little bit about the
00:30surgeon's console of the robot and then we will demonstrate you the entire surgery from the
00:35beginning to the end here we are using this forearm da vinci surgical robot and this is called surgical
00:42console this is the surgical console where the surgeon will sit and surgeon console has the
00:49this is the viewport that you will use to see inside and inside you will see completely
00:55three-dimensional so this is called as viewport now this is left side port this is right side
01:01port and this is master controller master controller when you will move it seeing inside the viewport
01:07you will just move the master controller and your movement of the hand will be translated inside the
01:13abdomen of the patient and this way da vinci robotic surgery can be performed so let us start the
01:20procedure and before that we have to introduce the uterine manipulator here we are using the full circle
01:28colpotomizer uterine manipulator and this will be the you can see tenaculum of the uterine manipulator is
01:35catching the cervix
01:39and then you will hold the anterior and posterior leaf of the uterus
01:44and then you will start operating the instrument so you have the energy sources the foot is controlling
01:52the foot switch is controlling the monopolar and bipolar and this is left side is bipolar maryland
01:59and right side you have the monopolar seizures so you can attach monopolar and bipolar together also
02:07here we are using force fx covedian generator electro surgical generator
02:13and this is anterior leaf of the broad ligament is opened and slowly you can go up to the uv fold on
02:21the right side now this is the fallopian tube and major salpings the bipolar is coagulating fallopian
02:29tube and major salpings and scissors is cutting it this is how your controller has to be controlled by
02:35your right and left hand and master controller is very delicate and when you control it you should be
02:41careful that level of this controller should be at the level of your elbow and the wrist should be at the
02:47level of the elbow and your elbow should rest over the the da vinci viewport pad and this way you can
02:55usually sitting in the chair perform the surgery now this is the ovarian ligament and here it is
03:02now opening the uv fold the colpartumizer as you can see is pushing the uterus and this is uv fold is
03:09open and now bladder will be separated and slowly you can separate the bladder here you can see the
03:15crisscross pattern and now this is uterine artery of the right side right side of uterine artery is
03:21coagulated couple of time two three time and then you can cut it with the seizures during that the left
03:27hand will hold the bipolar and it is coagulating and right hand will support it and we can keep the
03:35seizures also together to control the bleeding and to just dissect the tissue so this is the master
03:43controller again we can see how it moves and this is now left side this is left side round ligament which
03:50is getting coagulated and together cutting with the seizures anterior and posterior leaf of the
03:56left side is open this is fallopian tube of the left side with the major salpings and this is ovarian
04:02ligament of the left side with the major ovarian and just like laparoscopic histectomy here also
04:09anterior and posterior leaf of the broad ligament is open and this is left side posterior dissection is done
04:15now this is left side uterine artery and this is the bipolar is coagulating the uterine artery and it
04:21is cut by the seizures so now this is almost over now assistant will push the corporatomizer this is the
04:29viewport you can you can see this is completely three-dimensional high definition and this viewport
04:35always your head should be inside the viewport if you remove the head out of the viewport your instrument
04:41will become freezed and then you cannot move your instrument so now this is colpotomy and this is
04:48anterior colpotomy here the seizures is cutting and colpotomizer is pushing hard and this is now
04:54right-sided colpotomy and this is now left-sided colpotomy and this is now posterior colpotomy and you can
05:03see utero-cycle ligament is intact and again remaining part of the anterior colpotomy is done and uterus is
05:10pushed out through the vaginal root itself now this is closure of the vault closure of the vault is
05:16very interesting step in the robotic hysterectomy because suturing is very easy by robot and this is the
05:23vault closure is going on we are using bob suture v-lock suture and the vault is closed so this is over
05:31thank you very much for watching this video have a nice day god bless you
Comments