My Experiences with SRS Needlein

Non Descent Vaginal Hysterectomy

Concept….Creation….

Application….

and……..Presentation

Dr.Sudhir ShahRajkot

One of the most dramatic change in the route of removal of the uterus during the last few years is switching over from

Abdominal to Vaginal

irrespective of its

descent

volume ( fibroids, Adenomyosis )

previous surgeries on it.

Pendulum swings from Abd. To Vag.since last couple of yrs

Gynecologists have started to believe that Every Uterus can be and should be removed VAGINALLY unless the route is contraindicated

Previously 80% of Hyst.were Abdominal A:V 80:20Now 70 % are Vaginal Hyst. V:A 70:30It differs from center to center

Vaginal Hysterectomy

ADVANTAGES

Quick and easy surgeryNo Visible scarFaster Recovery1 Night Hospital stayLess Convalescence PeriodLow ComplicationCost Effective as compare to Abdominal hys.

Since the Incidence of NDVHsurgery has increased

It is our endeavor to find out

quick and comfortable operative steps

to make the SURGERY more COMFERTABLE and EASY

Challenging step

In doing NDVH apart from opening Anterior and Posterior Pouch

Most challenging and time consuming step isTransfixation of Uterosacral and Mackenrodts and Ligation of Uterine Pedicle with

available 40 mm half circle needle As

The space is narrow and pedicle is deep in Vagina

With 40 mm Half Circle Needle

The problem starts from --where to catch the needle in the

Needle holder -- At which angle needle is to be

inserted in to the pedicle --some time tip of needle is lost and can not found on the other side of clamp

Repetitive unsuccessful attempt causes

distressing and disturbing expressions

on

Surgeon

and

more so on

Assistants

To overcome this

We thought

of trying

short straight needle

instead of

half circle.

We designed new 20 mm short straight needle

to make these steps comfortable and easy.

we made it from 18 no Butterfly scalp vein

When we tried it…….

It came out very easily

in ligating pedical and I could see

WOW

Expressions on the faces of my

Assistants

This….believe me…This

Encouraged me to try this needle

in more and more surgery of NDVH

and the TRIAL was more then

Satisfactory.

Technique

After cutting the pedicle the SRS needle Is inserted from below upwards so the tip of the needle emerges anteriorly in vision andit can be very easily catched and handled.It can also be inserted from above.

Needle is inserted from below

Here is the Schematic Representation

Schematic RepresentIt comes out in front..

Schematic Represent

Pulled out…..

Schematic RepresentReinserted to Transfix

Schematic Represent

Pulled out again …

Schematic RepresentWhen available space above the pedicle is more then below the pedicle

This shows How Difficult wrist joint movement is with half Circle needle. It gives PAIN at wrist and shoulder joint

Here is an easy movement with short straight needleNo Pain at wrist or shoulder joint

40 mm half circle Needle

20 mm Straight Needle

insertion in the Pedicle is difficult

insertion in the the Pedicle is easy

40 mm half circle Needle

20 mm Straight Needle

Surrounding structures may injured

Surrounding structures like lateral wall of vagina and lateral part of pedicle are not injured

40 mm half circle Needle

20 mm Straight Needle

More space required to handle the needle

Less space required to handle the needle

40 mm half circle Needle

20 mm Straight Needle

Movement of the wrist Joint is quite Difficult

Movement of the wrist Joint is quite Easy

Our Experience

Since last 9 years we are using this needle in NDVH.We did more then 3000 Vaginal Hyst. Withthis types of straight suture needle andwas found convenient easy time savings and with least wrist joint movement

Now Available in Market SRS Needle – PETCRYL- FS 2545

Dolphin Sutures