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https://www.laparoscopyhospital.com/drrkmishra.htm Advancements in Hysterectomy: Step-by-Step Tutorial on TLH and BSO with ICG Enhancement Hysterectomy stands as a frequently performed gynecological surgery, witnessing substantial advancements over time. Total Laparoscopic Hysterectomy (TLH) and Bilateral Salpingo-Oophorectomy (BSO) are at the forefront of these developments. The incorporation of Indocyanine Green (ICG) fluorescence imaging into these surgeries marks a significant leap, enhancing visual clarity and improving safety. 1. Overview of TLH and BSO TLH, a minimally invasive technique for uterus removal, contrasts sharply with conventional surgical methods. BSO, entailing the extraction of both ovaries and fallopian tubes, often accompanies TLH. These procedures address a range of medical conditions such as uterine fibroids, endometriosis, and ovarian cancer. 2. The Enhanced Visualization through ICG Indocyanine Green, a medical imaging dye, illuminates under near-infrared light. Upon intravenous administration, ICG adheres to blood proteins and remains within the circulatory system. This characteristic enables surgeons to accurately observe blood flow and tissue health. In TLH and BSO, ICG proves crucial for delineating critical structures like blood vessels, ureters, and tumor margins. 3. Pre-Surgical Preparations The selection of appropriate candidates for TLH and BSO using ICG is pivotal. Detailed discussions regarding the merits, risks, and alternatives of these procedures are essential. Pre-surgical imaging and preparations, including bowel regimen, are vital to optimize surgical conditions. 4. Sequential Steps of the Surgical Procedure - Step 1: Anesthesia and Patient Positioning - General anesthesia is administered, positioning the patient for optimal pelvic access. - Step 2: Setting up Trocars and Insufflating the Abdomen - Small incisions are made to insert trocars, followed by abdominal insufflation with gas. - Step 3: Administering ICG - Post initial pelvic examination, ICG is injected. - Step 4: Identifying Vital Structures - Surgeons use near-infrared cameras to spot and safely navigate around vital structures. - Step 5: Managing the Uterus - Specific instruments are employed for uterine manipulation, facilitating easier dissection. - Step 6: Excising and Removing Tissues - The uterus, and possibly ovaries and fallopian tubes, are meticulously excised and extracted. - Step 7: Securing Hemostasis and Wound Closure - After ensuring no active bleeding, the surgical sites are closed. 5. Post-Surgery Care and Convalescence Postoperative management includes pain control, monitoring for potential complications, and encouraging early movement. Recovery durations can vary, with most patients reporting reduced discomfort and a faster return to daily activities in comparison to traditional surgery. 6. Advantages and Constraints ICG usage in TLH and BSO provides heightened safety and precision. However, it necessitates specific equipment and expertise. The cost and accessibility of such technology may restrict its widespread adoption. 7. In Conclusion Incorporating ICG in TLH and BSO signifies a major progression in the realm of gynecological surgeries. This technique bolsters the safety and effectiveness of these procedures, leading to improved patient outcomes. With ongoing technological advancements, these methodologies are expected to become more accessible, further transforming surgical practices. This article is intended as a foundational guide and should be complemented with comprehensive training and adherence to the latest clinical standards for surgeons.