Name:
ACM Williams GYN 4e: Uterine Manipulators with Colpotomy Cups
Description:
ACM Williams GYN 4e: Uterine Manipulators with Colpotomy Cups
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/f97e0cb1-8922-4557-b16c-ce1abb11822b/thumbnails/f97e0cb1-8922-4557-b16c-ce1abb11822b.jpg?sv=2019-02-02&sr=c&sig=fZtOjP9i9MBiZPM9m7mX9fPzoesq9MSG%2F5U4jQ9LOxI%3D&st=2024-05-04T10%3A35%3A18Z&se=2024-05-04T14%3A40%3A18Z&sp=r
Duration:
T00H02M41S
Embed URL:
https://stream.cadmore.media/player/f97e0cb1-8922-4557-b16c-ce1abb11822b
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/f97e0cb1-8922-4557-b16c-ce1abb11822b/Uterine20Manipulators20with20Colpotomy20Cups20-20R1.mov?sv=2019-02-02&sr=c&sig=Y9K3iAn1tb85nftjTUa7qHvAXYtSTSwxznnCdaNNvp8%3D&st=2024-05-04T10%3A35%3A18Z&se=2024-05-04T12%3A40%3A18Z&sp=r
Upload Date:
2022-02-27T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
LAURA: In this video, we provide a guide of how to manipulate uterine manipulators with colpotomy cups. The most important distinction between uterine manipulators is the presence or absence of a colpotomy cup. Manipulators with the colpotomy cup are indicated for laparoscopic hysterectomies, in which creating a colpotomy is necessary. The proximal rim of the cup delineates the cervicovaginal junction where proper amputation of the uterus occurs. The rim provides a visual cue as it creates the appearance of a bulge and also a tactile cue through the sensation of a solid object when palpitated laparoscopically.
LAURA: The RUMI and VCare are two of the most well-known uterine manipulators that include the option of a colpotomy cup. In addition, both devices include an intrauterine tip with balloon, a mechanism for pneumo-occlusion, an option for chromopertubation, and a sturdy handle for a comfortable manipulation. An important difference between the two is that the VCare is disposable, whereas a portion of the RUMI is reusable. Regardless of the manipulator chosen or its functionality, movement of the uterus is accomplished by applying a concept of a fulcrum.
LAURA: A fulcrum is the point on which a lever rests or is supported and on which it pivots. During laparoscopic surgery, the cervicovaginal junction acts as a fulcrum around which the uterus is manipulated. Therefore, deviating the manipulator handle and cervix results in the uterus moving in the opposing direction. Applying this concept to expose the right side of the uterus and adnexa, the handle of the manipulator is deviated towards the patient's right leg, sending the uterus towards the patient's left pelvic sidewall.
LAURA: To expose the left side of the uterus and adnexa, the handle of the manipulator is deviated towards the patient's left leg sending the uterus towards the patient's right pelvic sidewall. Moving the handle towards the floor elevates the uterus towards the patient's anterior abdominal wall. At the time of colpotomy, directing movement of the uterine manipulator cephalad will effectively delineate the cervicovaginal junction and increase the distance of the uterus from the colpotomy.
LAURA: With proper pressure, this movement accentuates tension along the colpotomy line, facilitating the creation of clean vaginal cuff edges. These movements can be challenging for new assistants. Confusion about which direction to move the uterus can be decreased by placing a monitor in front of the surgeon manipulating the uterus, as opposed to off to the side or behind them where the ergonomics are less intuitive.