NEW SURGICAL TECHNIQUE
“Esthetic caesarian section in VIII layers in 12-16 minutes”
Dr. Victor Torres Amoretti (1)
Dr. Nicolas Hernández Hernández (2)
(1) Professor of the Medical Faculty of the Peruvian Amazon University
Chief of Gynecology and Obstetric Department of Hospital “César Garayar García”
Iquitos city -Peru
Email victortoresamoretti@hotmail.com
Dr. Nicolás Hernández Hernández
Assistant of Gynecology and Obstetrics Department
Hospital “ César Garayar García”
Iquitos city-Peru
DESIGNED FOR SURGICAL DURATION OF 12-16 MINUTES
- ASEPSIS AND ANTISEPSIS OF THE ABDOMINAL WALL
- PLACEMENT OF SURGICAL DRAPES
THE UTERINE CAVITY APPROACH
- Modified Pfannenstiel incision: horizontal skin tent traction equally distant from alba midline.
- A 12 cm inferior curvature transversal section is done.
- Centrifugal thumb dissection of subcutaneous fatty layer.
- Transversal curvature section of aponeurosis.
- Separation of upper aponeurosis flap with laparotomy pad.
- Index and middle finger separation of abdominal rectus muscles.
- Digital centrifugal separation and opening of parietal peritoneum.
- Placement of laparotomy pad in each parieto-colic space.
- Separation of bladder by left hand of first asssistant.
- Traction of visceral peritoneum with kelly and digital aperture.
- Small horizontal uterine paracervical incision with scalpel is done and opened with kelly clamp, followed by careful centrifugal digital separation of uterine cavity.
FOETAL EXTRACTON AND CLOSURE
- Clamp and section of umbilical cord.
- Manual extraction and and revision of the placenta.
- Revision and cleaning of uterine cavity with laparotomy pad.
- Closing of uterine wall in three layers using catgut chromic 1. First layer: continued cross surjet; second and third layer with simple continued surjet.
- Traction of parietal peritoneum and extraction of laparotomy pads from parieto-colic spaces. Purse string suture of parietal peritoneum with catgut chromic 1.
- Aproximation of rectus abdominus muscles with catgut chromic 1
- Crossed continued surjet of aponeurosis of muscles with Dexon or Vicryl No.1.
- Hemostasis and closing of subcutaneous fatty tissue with catgut chromic 00, including Scarpa fascia to prevent umbilication of cutaneous scar.
- Esthetic subdermic skin closure with Nylon No.1
ADVANTAGES FOR THE MOTHER AND CHILD
- Conservative surgical technique for emergency and elective caesarian sections.
- Surgical time of 12 – 16 minutes. Rapid extraction of foetus (under 2 minutes).
- One anaesthetic is used with minor dose and there is minimum time of exposure.
- The Pfannenstiel incision modified by Torres Amoretti using “tent traction” results in an approach with no significant blood loss.
- Emphasis is placed in digital dissection-digitopraxis with minimum blood loss and use of instruments in the approach.
- Reparation of tissue is done with suture saving measures (surjets, purse string and subdermic closure).
- Surgical and anatomic approximation of each separate layer.
- Esthetic scar when Scarpa fascia and subdermic skin is closed.
- Rapid recovery enabling walking, feeding and leaving hospital soon.
- Prevents post laparotomy hernias, eventrations and suture rupture.
- Permits minor possibilities of bands and adhesions.
- Prevents endometriosis.
- Permits more uterine resistance enabling possibilities of vaginal deliveries in future pregnancies.
- The experience of more than 2000 operated cases in the Hospital “César Garayar García” which has been rewarded in Peru with the banner reflecting safe maternity in the “Ten steps for safe deliveries”.
OTHER ADVANTAGES OF THE NEW SURGICAL TECHNIQUE
- Minor time and stress for the surgeon in the operating theater.
- Less consume of oxygen and other operating theater material.
- Less use of equipment and instruments of the operating theater.
- Less waiting time for the family.
- Less bed- patient costs.
BIBLIOGRAPHY
TRADITIONAL CAESARIAN TECHNIQUES
Pelosi – Caesarian section in layers. Operating time 45 minutes.
NON CONSERVATIVE TECHNIQUES FOR CAESARIAN SECTIONS
- Misgav Ladach – Tel-Aviv, Israel. Surgical closure in three layers. Operating time 20-25 minutes.
- Elmar Armin Joura – Viena – Austria. Viena General Hospital. Surgical closure
in three layers. Operating time 20-25 minutes.
- Carlos Alberto Becker-Hospital “Durand”-Argentina.Misgav Ladach technique: surgical closure in three layers. Operating time 20-25 minutes.
Javier García Gonzales – Hospital “La Mancha”. Alcázar de San Juan- Spain. Modified Misgav Ladach technique. Closure in three layers with staples. Operating time 20-25 minutes.
