Abstract
Hysterectomy is the surgical removal of the uterus. It may also involve removal of the cervix, ovaries, fallopian tubes and other surrounding structures. Hysterectomy is the most common procedure performed for gynecological disorders. It is expected that the frequency of hysterectomies for non-malignant indications will decrease as there are good alternatives in many cases. However, hysterectomy will remain as the definitive treatment of uterine pathology. Vaginal hysterectomy, is the original method of minimally invasive hysterectomy while abdominal hysterectomy is the most invasive method of hysterectomy. The introduction and rapid advancement of the laparoscopy has allowed for the development of alternative minimally invasive approaches to hysterectomy in order to avoid the morbidity associated with an abdominal approach when the vaginal approach is not feasible. Initially, laparoscopy was added to aid assessment and treatment of adnexal pathology or endometriosis in combination with a vaginal hysterectomy. As tools and techniques advanced, a greater proportion of the hysterectomy procedure was undertaken using the laparoscopic approach leading to the first total laparoscopic hysterectomy successfully completed via laparoscopy in 1989. Following this, the development of tools that facilitated dissecti on, vessel sealing and suturing were developed in order to simplify and improve the procedure. The many advantages of the minimally invasive approach for the patient led to the desire to utilize this approach even in complex hysterectomy procedures, obese patients, and cancer surgeries. This motivated surgeons and the industry as whole to push the limits of the surgery, and to develop and explore other laparoscopic approach es such as single port surgery, mini-laparoscopy, natural orifice surgical procedures (NOT ES). The most advanced and expensive tool used to date for the performance of minimally invasive hysterectomy procedures is the daVinci (TM) surgial robot which received FDA approval for the procedure in 2005, after which the frequency of daVinci robotic assisted total laparoscopic hysterectomy has exponentially increased. This chapter will review many of the tools utilized in hysterectomy, including uterine manipulators, with a focus on the specialized tools utilized in robotic assisted procedures.
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Orady, M.E. (2018). Instruments, Apparatuses and Uterine Manipulators for Hysterectomy with Special Focus on Robotic-Assisted Laparoscopic Hysterectomy. In: Alkatout, I., Mettler, L. (eds) Hysterectomy. Springer, Cham. https://doi.org/10.1007/978-3-319-22497-8_57
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DOI: https://doi.org/10.1007/978-3-319-22497-8_57
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