8493 Six Clip Hysterectomy

Abstract

<h3>Study Objective</h3> To demonstrate an efficient, alternative method of performing a total robotic hysterectomy with bilateral salpingo-oophorectomy/salpingectomy using six surgical clips. <h3>Design</h3> Video presentation with narration explaining surgical technique and steps to perform a hysterectomy with six surgical clips. <h3>Setting</h3> Hospital operating room. Patient positioned in dorsal lithotomy in steep Trendelenburg with robot docked in place. Surgeon at console. <h3>Patients or Participants</h3> A 54-year-old woman with pelvic pain and thickened endometrium with history of endometrial ablation years prior for menorrhagia. She presented for total robotic hysterectomy with bilateral salpingo-oophorectomy. <h3>Interventions</h3> The patient was taken to the operating room for a robotic hysterectomy with bilateral salpingo-oophorectomy. The abdomen was entered and the da Vinci Xi robot (da Vinci Intuitive Surgical, Sunnyvale, CA) was docked. The left round ligament was transected, and the retroperitoneal space was entered. Using a large robotic clip applier, a surgical clip was placed on the left uterine artery at its origin. A second clip was placed on the left infundibulopelvic ligament which was then transected. A third clip was placed on the left uterine vessels at the level of the cardinal ligament. The steps were repeated on the opposite side. After the sixth and final clip was placed on the right uterine vessels, the cardinal ligaments were transected bilaterally and the colpotomy was completed. The specimen was removed, while the six surgical clips remained in the body. Minimal bleeding was encountered. Patient recovered well post-operatively with no issues. When performing a hysterectomy with bilateral salpingectomy, the clips are placed on the utero-ovarian ligaments as opposed to the infundibulopelvic ligaments. <h3>Measurements and Main Results</h3> N/A. <h3>Conclusion</h3> We demonstrate an efficient, cost-effective, and alternative method of performing a robotic hysterectomy using six surgical clips. There is less energy use, less thermal damage, and decreased blood loss. This technique is applicable with both bilateral salpingo-oophorectomy and bilateral salpingectomy at the time of hysterectomy.