Chapter 1
Introduction
Rationale
Health professionals frequently believe that advanced laparoscopic surgeries are generally only accessible to patients in developed countries. They also are of the opinion that laparoscopic equipment is costly and that to master advanced techniques, one has to attend expensive training sessions. The authors, on the other hand, firmly believe that these opinions are not true and in this volume have set forth to show how and why things are really different.
This publication shows or proposes new laparoscopic techniques; moreover, it shows how to perform laparoscopy and, in particular laparoscopic hysterectomy, more simply, more easily and at less expense. We are not writing about cheap instruments, but about the elimination of the clutter that has accumulated over the years and has contributed to the generally held impression that advanced techniques are extremely costly, laborious and labor intensive.
Having said this, it is important for the reader to realize that mastering the technique of laparoscopic hysterectomy requires diligence, dedication and developing a team of assistants to guarantee that all is ready and workable when it is needed. Time wasted looking for instruments that are ‘down the hall’ is to no one’s advantage and, in the long run, costs money. The number of instruments that are required for laparoscopic hysterectomy is not great, but they must be present and in working order before the patient enters the theater.
The ‘evidence’ behind the rationale we propose is based upon the personal operative experience of Dr Rajendra Sankpal, one of the leading laparoscopists of India. He began his laparoscopic practice after completing the FIGO Fellowship in Chicago, USA. During this Fellowship, he worked under Drs Charles Koh, the late Harry Hasson, Andrew Brill and other leading American laparoscopic surgeons. Prior to undertaking this training, he had the opportunity to work under Professor Arnold Wattiez of France. By working with these great personalities, he not only absorbed their unique skills, but also began to think about simplifying the complicated aspects of advanced laparoscopic surgery in order to take it back to his home in India. Through this book we attempt to introduce all those tricks and tips to make laparoscopic hysterectomy simple.
Our final aim is to prepare an average gynecologist who has had experience with simpler forms of laparoscopy, and perhaps some experience at what may be defined as advanced work, to develop more extensive skills with an idea of advancing to perform laparoscopic hysterectomy with safety in mind.
If our aim is achieved, it will help physicians to contribute to their country’s prosperity, as more women spend less time in the hospital, recover faster and look after the family or start working once more in the field, in the office or at home.
Introduction
This book presents a series of steps which must be mastered individually. By approaching the operation in this manner, one reduces the time taken to master the learning curve necessary to perform a complete laparoscopic hysterectomy. By understanding good instrumentation techniques, for example, the known complications of laparoscopic hysterectomy will be avoided. The authors demonstrate how, by correctly using minimal instruments, one can perform total laparoscopic hysterectomy (TLH).
This book illustrates how one can be cost-effective and use a minimum number of ports. It also demonstrates the steps of TLH which are universal for all cases and for numerous varieties of uteri. The steps of TLH described in this book are easily reproducible if the reader carefully follows all of them, including those presented and discussed in the videos. The final intent of the authors is that the reader should be able to master safe surgical technique of TLH in a cost effective and reproducible manner.