Trend towards minimalisation

A number of different options are available in operative gynaecology in order to carry out surgeries as gently and precisely as possible. Besides conventional open techniques, minimally invasive surgery is becoming increasingly important. The most common clinical pictures requiring surgical intervention include:

• Myomas
• Bleeding disorders
• Endometriosis
• Fibromas
• Cervical cancer

Despite regressing case numbers, the hysterectomy is still the most common type of surgery in gynaecology today¹. Indications for hysterectomy include uterus myomatosus in approximately 30 per cent of all cases, bleeding disorders in 25 per cent, endometriosis in 16 per cent, followed by pain (11 per cent), malignant tumours (10 per cent) and other clinical pictures (10 per cent)².

Different surgical techniques are available for a hysterectomy. In the case of malignant tumours, abdominal hysterectomy by means of abdominal incision is still the preferred technique. In most cases, the procedure is performed as classical total hysterectomy.  

Surgeries for benign tumours and indications such as myomas and endometriosis can also be performed vaginally or with laparoscopy. Moreover, surgeons and patients have the choice between total hysterectomy or supracervical hysterectomy. With the appropriate indication, laparoscopic supracervical hysterectomies (LASH) are increasingly replacing vaginal hysterectomies.

Laparoscopic assisted hysterectomy
Whether total or supracervical – laparoscopic interventions are increasingly being used for hysterectomies. In such cases, modern ultrasound instruments cause minimal tissue damage and, in addition, minimise blood loss. Ultrasound can be used for tissue dissection and coagulation at a frequency range of 55 kHz, since the walls of the blood vessels adhere to one another and thereby lead to occlusion. This effect is very selective and enables a precise procedure during dissection and coagulation.

Advantages of the Söring ultrasonic instruments:

• Less haemorrhaging and therefore improved view of the operating site for the surgeon
• No visible formation of smoke
• Low-risk dissection and coagulation since there is no current flowing through the patient
• Ergonomic handling
• Cost efficiency through reusability

1 Schüssler B, Scheidel P, Hohl MK.
Hysterectomy update: What is “state of the art”? Frauenheilkunde Aktuell, Schweiz, 17/3/2008.
2 According to US studies (Med. Sci. Monit 2008)

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