Abstract
<h3>Study Objective</h3> Minimally invasive hysterectomy has several benefits but is not universally offered for large fibroid uterus as it is technically challenging to perform by laparoscopy. The main objective of this video is to discuss 5 strategies that can make robot assisted hysterectomy for large uterus feasible using only two operative ports. <h3>Design</h3> Step-by-step video demonstration of the five strategies. <h3>Setting</h3> A tertiary care teaching hospital. <h3>Patients or Participants</h3> Robot Assisted Laparoscopic Hysterectomy in patients with large fibroids. All cases were clinically more than 16 weeks. <h3>Interventions</h3> Robotic assisted Laparoscopic Hysterectomy Surgery using the DaVinci Si system. <h3>Measurements and Main Results</h3> Five strategies are demonstrated in this video. Strategy 1-Port placement at Umbilicus irrespective of the size; Strategy 2- Finding the space for the utero-vesical fold and bladder dissection; Strategy 3- "Hugging the uterus" technique for intraoperative uterine manipulation; Strategy 4 -"The Salsa" maneuver for coagulating and transecting uterine pedicles; Strategy 5- Colpotomy with skillful rotation of a 30<sup>0</sup> telescope, intraoperative myomectomy and partial amputation of uterus. <h3>Conclusion</h3> We have used these strategies for more than 200 cases with large and multiple fibroids with conversions in only two cases. Using two instruments to perform robotic hysterectomy even for large uterus thus making it economical. These simple strategies can be adopted across the globe making robotic hysterectomy economical and feasible.
Published Version
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