|
Dr. Sudhir Shah
(shahsudhir@yahoo.com)
SRS Needle
Easy Step in
Non Descent Vaginal hysterectomy
Comparision
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 the decent of the
uterus, volume (fibroids, Adenomyosis) or previous surgeries
on it. While doing Non Descent Vaginal Hysterectomy, apart
from opening Anterior and Posterior pouch most challenging
and time consuming step is transfixation of Uterosacral ,
Mackenrodts ligaments 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
(1) Where to catch the needle in the Needle holder.
(2) At which angle needle is to be inserted in to the
pedicle
(3) 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 disturbing situation I thought of trying
short straight needle instead of half circle. I designed new
15 mm short straight needle to make these steps comfortable
and easy.
Technique After cutting the pedicle the
SRS needle is inserted from below upwards, as shown in the
image, so the tip of the needle emerges anteriorly in vision
and it can be very easily caught and handled. It can also be
inserted from above and to catch from below. Since last 4
years we are using this needle in NDVH. We have done last
1000 Vaginal Hysterectomy with this types of straight needle
and was found convenient, easy, time savings and with least
wrist joint movement
The SRS needle in now available in
market by Dolphine Sutures as PETCRYL* SRS FS 2545.
Comparision of Short Straight Needle –SRS Needle with 40 mm
half circle Needle .
|
40 mm Half Circle Needle |
15 mm SRS Needle |
|
Technically Difficult |
Technically Very Easy |
|
Movement Difficult |
Movement Easy |
|
Surrounding structures may injured |
Surrounding structures not injured |
|
Difficult in transfix Pedicle |
Easy in transfix Pedicle |
|
More space required to handle the needle |
Less space required to handle the needle |
Since the incidence of Vaginal
hysterectomy is increasing day by day and more and more
gynec surgeons are adopting this route for the removal of
uterus we have to find out more and more easy and safe steps
for the surgery. This new technique is very easy for
ligating pedicles apart from its high safety. |
