TOTAL LAPAROSCOPIC

HYSTERECTOMY
using
SINGH
MANIPULATOR, FUNNEL and HANDSFREE
PELVIC ASSISTANT (PA)
 Instruments used
• Uterine Manipulator • HANDSFREE (PA)
• Vaginal Funnel PELVIC ASSISTANT
• Uterine Artery Needle
Tie
• Uterine Hook
Dissector
• Pelvic Probes
• Vaginal Plug
 SET UP
• Place patient in lithotomy.
• Make sure the symphysis pubis is over
the end of the operating table, not just
the buttocks. This will ensure that
maximum anteversion can be achieved
when required.
INSERT FOLEY’S CATHETER.
ATTACH VULSELLUM TO CERVIX.
DILATE CERVIX WITH STRAIGHT END OF
INNER ROD. DO NOT DILATE ANY MORE
THAN DIAMETER OF INNER ROD.
SOUND THE LENGTH OF THE UTERINE
CAVITY WITH THE INNER ROD.
INSERT CURVED END OF MANIPULATING
ROD INTO CERVIX UP TO UTERINE FUNDUS.
USE STRAIGHT ROD FOR LSH, AS ROD CAN
BE RETRACTED FROM UTERUS DURING
MORSELLATION.
SLIDE UTERINE CANNULA ON
MANIPULATING ROD UP TO CE
HOLD ON TO ROD WITH OTHER
PREVENT IT FROM BEING PUS
FUNDUS.
SCREW CANNULA INTO CERVIX UP TO LEV
THE O RING.
IN FIRST FEW CASES, I SUGGEST PLACING
SUTURE (1 NYLON) AT 12 O’CLOCK ON THE
ECTOCERVIX AND TIE AROUND THE CANNU
FEW TIMES. REPEAT AT 3 O’CLOCK IF OS IS
PATULOUS OR UTERUS IS VERY LARGE.
THIS WILL ALLOW YOU TO DELIVER THE UT
AT THE END OF THE PROCEDURE. OTHERW
WILL HAVE TO INSERT A VULSELLUM INTO
VAULT TO GRAB THE CERVIX.
MANIPULATOR SCREWED INTO
CERVICAL OS
SLIDE FUNNEL ALONG UTERINE CANNULA.
REMOVE VULSELLUM FROM CERVIX.
PUSH FUNNEL ALONG UTERINE CANNULA
INTO VAGINA WITH THE EDGE OF THE
FUNNEL PLACED POSTERIORLY.
PUSH FUNNEL FIRMLY INTO THE VAGINA
AGAINST THE VAGINAL VAULT.
FUNNEL ON MANIPULATOR
PLACE BLACK OR WHITE HOLDING SCREW
BEHIND FUNNEL SHAFT TO PREVENT IT
SLIPPING OUT OF THE VAGINA.
YOUR PELVIC ASSISTANT NOW HOLDS THE
CANNULA OR YOU CAN ATTACH IT TO THE
HANDSFREE PA.
THIS IS THE FINAL SET UP IN THE PATIENT.
ROTATE THE FUNNEL SHAFT TO PRESENT THE EDGE FOR
DISSECTION.
PLEASE NOTE NEW SINGLE PIECE FUNNELS HAVE
REPLACED SCREW ON MODELS.
THE INNER ROD CAN BE PUSHED, WITHDRAWN OR
ROTATED UNDER LAPAROSCOPIC CONTROL TO
FURTHER MANIPULATE THE UTERUS.
VAGINAL PLUG
TO STOP CO2
LEAK DURING
COLPOTOMY.
PUSH ONTO
FUNNEL WHEN
LEAK OCCURS.
PUSH PLUG ONTO
FUNNEL TO BLOCK
INTROITUS ONLY
WHEN LEAK
OCCURS