Abdominal Hysterectomy in benign or malignant conditions using ebvs or sutures. Mounir M F Elhao Prof Ain Shams University, president of EGCS

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Abdominal Hysterectomy in benign or malignant
conditions using ebvs or sutures.Mounir M F
Elhao Prof Ain Shams University, president of
EGCS
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Surgical suture

• . They must be strong.
• non-toxic and hypoallergenic,
• and flexible knotted easily).
• they must lack the so called "wick effect.

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Absorbable sutures

• Are made of materials which are broken down in
  tissue after a given period of time, from ten
  days to eight weeks.
• .
• The fact that it disappears is an advantage, as
  there is no foreign material left inside the body
  and no need for the patient to have the sutures
  removed.

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Absorbable sutures

• Occasionally, absorbable sutures can cause
  inflammation and be rejected by the body rather
  than absorbed.

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Nonabsorbable sutures

• not metabolized by the body, and can be used in
  some inner tissues in which absorbable sutures
  are not adequate.

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Mechanical haemostatic devices

• have been used in various parts of the body,
  including gastro-intestinal applications. Such
  devices are typically in the form of clamps,
  clips, staples, sutures, etc. that are able to
  apply sufficient constrictive forces to blood
  vessels so as to limit or interrupt blood flow.

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CLIPS

• . Similar types of clips having a pair of arms is
  that it may often be necessary to rotate the clip
  to properly grasp the area to be clipped.
• Accordingly, there is a need for a clip that can
  be delivered to the target area and used without
  having to rotate the clip to a desired
  orientation.

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CLIPS

• Difficulty in securing the clip device to the
  delivery apparatus prior to reaching the target
  area

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CLIPS

• Difficulty in properly positioning these devices
  to grasp the area to be clipped when the surgical
  site is obscured by blood or other bodily fluids

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EBVSelectrosurgical bipolar vessel sealing

• Seals vessels from 1 to 7 mm in diameter,
• Precise amount of bipolar energy and mechanical
  pressure to fuse collagen and elastin within the
  vessel walls.
• withstand a minimum of three times normal
  systolic pressure. The result is permanent

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EBVS

• Single application.
• Avoids needlestick injuries
• Visible, possibly translucent seal The seal is
  created using the bodys own collagen to actually
  change the nature of the vessel walls and
  obliterate the lumen.

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EBVS

• Patented Instant Responsetechnology
• the type of tissue in the Instrument jaws and
  delivers appropriate amount of energy needed to
  effectively seal it.

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The seal mechanismThe collagen and elastin
withinthe tissue melt and reform to create the
seal zone
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tissue bundle
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THE STUDY.
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• Setting
• Was carried out in Ain-shams University
  maternity Hospital.
• Study group
• Women admitted for abdominal hysterectomy for
  benign disease or radical hysterectomy for
  malignant disorder.
• Type of the study
• Prospective randomized controlled study using a
  computer program ( Random allocation software
  version 1.0).

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• 60 patients any type of abdominal hysterectomy
  randomized into two groups
• ( total abdominal(T) and radical (R)
  hysterectomy)
• into 4 groups ( 15 patients each)
• Group TL TAH using (EBVS)
• Group RL RAH using (EBVS)
• Group TS TAH using traditional suturing
• Group RS RAH using traditional suturing

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• No matter what
• vessel, artery, or tissue bundle
• VesselSealing System can seal it.

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Reduced sticking and charring Minimised need
for multiple applications No dislodged clips
No foreign material left behind
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sealing produces significantly reduced
thermal spread with virtually no charring, and
with minimal thermal spread to adjacent tissue.
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• There was statistical significant difference
  between the 2 groups as regard the associated
  operative procedures as 2 patients underwent
  resection anastomosis and isolated vaginal cuff
  removal..

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CONCLUSIONS
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EBVS

• Minimizes the need for multiple applications
  Potential time savings compared to suture May
  reduce blood loss in some surgical procedures
• Permanent seal
• leaves no foreign material behind

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• THANK YOU FOR YOUR ATTENSION