Tubal Ligation with a Filshie Clips

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that everything else is okay she’s had
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two normal deliveries so we do not
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expect additions slight more head low
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less so initially I prefer to put a 5 mm
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put and we take a look again because of
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a steep head low what happens is the
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small bubble which has got some fluid
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content tends to fall up towards the
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diaphragm and the sigmoid you can simply
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flip it up and it usually stays up
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uterus is appearing normal can see both
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the tubes very comfortably
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now there is an option of whether you
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want to put a dilator 2nt where the
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uterus or not so in this case what I am
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planning to do is to put in a dilator
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separate carafe
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out
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so this is a simple dilator and it will
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help to intimate support
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now for the purpose of the finish
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eclipse or for even for that matter the
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band’s what you need to put is the 7mm
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port so we remove the 5mm and from the
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same put in the 7mm port
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so the fill she clips they come with a
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clip applicator some same thing
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something similar to the band applicator
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which is again a 7mm instrument
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[Music]
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[Music]
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so this is the silly clip as you can see
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it’s loaded onto the clip applicator and
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this end is going to get pushed when I
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squeeze this end will get pushed below
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the outer end so then it seems and there
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is silastic material in between which
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will occlude the tube completely so when
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I lift I can see that it goes below the
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tube and the tube is going to get
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squeezed
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so this is the Phil Shi clip applied on
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one tube so that silastic material is
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going to cause the fibrosis of the part
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of the tube only as much as it is held
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inside the clip so this is minimum
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trauma now we note the second clip
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so again you can see that the second
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clip is loaded so it is going to get
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squeezed below the outer end and here
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you can see the outer end much more
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clearly and gently squeeze huh hello yes
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this one I will talk you a little later
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yeah so this is the second clip which is
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now applied and it’s a very very
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comfortable procedure that the amount of
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damage is very very minimal so the
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procedure is done now I prefer to give a
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wash so what we are going to do is
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remove the 7 mm again and from the same
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port we put in the 5 mm and give a wash
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I prefer to give a wash in every case
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Plus leave around 7 to 800 CC of saline
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at the end of every case so the
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procedure actually takes hardly 3 to 4
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minutes but I think compared to using a
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band it’s much more comfortable to use
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the fill she clip because there is
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absolutely no extremist or trauma to the
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patient when you use a band around two
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and a half centimeter of the tube is
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undergoing ischemia and that itself
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causes significant pain in the
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post-operative period to overcome that
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pain when we were using the standard
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tubular black bands I used to put sensor
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cane into the broad ligament
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5-cc of circle to a two to two and a
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half CC on each side I would prefer to
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put into the musical things over here so
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the pain sensation was less in the
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post-op period for those patients but
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ever since we have started using the
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fill she clips there is absolutely no
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pain and it is almost as good as no
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procedure has been done currently
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this is very comfortable and again we
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will leave around 7 800 cc or saline
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inside it helps because we anyway don’t
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give post-operative IV fluids plus it
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helps in removing the gas so there is
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absolutely no incidence of shoulder pain
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to any of the patients undergo so very
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comfortably placed and overweight sensor
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cane and again we will put 5 to 10 CC of
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sensor cane into the peritoneal cavity
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now
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fill the top
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hello yes yes very good morning I want
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to know I shot pussy and watch Anastasia
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is preferred intubation is they you do
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interest or incubation or a short either
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listening we prefer to use GA for all
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the cases Tara hear me yeah I can’t hear
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you that yeah we prefer to use GA for
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all the patients even if it is a small
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procedure like the tubal ligation right
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now ah the Jew interviewed intuition in
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full gear with intubation what we have
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been using is only laryngeal mask we
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don’t intubate any of the patients even
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for an instructor lower limb ectomy and
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with luring air mask the anesthetic
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agents which we prefer to use nowadays
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even if the action has to be under for
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only 10 minutes it’s equal to
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comfortable I can’t hear you sir even if
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we have to use it for 10 minutes it
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comes actually in fully comfortable okay
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okay yeah okay yeah thank you sir thank
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you