[Script Info]
Title: 
[Events]
Format: Layer, Start, End, Style, Name, MarginL, MarginR, MarginV, Effect, Text
Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,Now we are going to close the uterine incision
Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,The uterine incision, the first thing would be to identify the angle
Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,because that's where the most risk of bleeding occurs
Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,so we should be sure that we have identified and start our sutering from the angle of the uterine incision
Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,and we are going to use usually vciril or chromic cat gut can also be use
Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,the stitch is going to be continuous
Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,suturing, after we grasp, make sure we have got the angle we'll go by doing continuous suturing
Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,and sometimes if we are doing, if we are having heavy bleeding, we can use locking sutures
Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,but if we feel the bleeding is controlled we don't have to lock the sutures
Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,while the surgeon is doing this continuous suturing, the assistant's role is a big role here
Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,holding the uterus still, preferably by
Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,using a pack
Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,and also holding the suture also
Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,by following the surgeon and hold the suture tight
Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,and once we have done
Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,in this video, you'll see that the surgeon is going to close the uterine incision
Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,in one layer
Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,and now there are two schools of thoughts about the uterine closure
Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,either it could be closed in one layer or two layers
Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,some studies have shown that using one layer closure decreases operation time
Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,with still the same kind of results
Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,still some would argue that the risk of bleeding and risk of future infection
Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,and disheasance would increase with one layer
Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,both ways are acceptable
Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,but usually in our practice, in our set up what we practice is using two layer approach
Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,so we are finish putting suture with one layer, then we are repeat the same procedure and close uterine incision in two layers
Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,and nowadays, we have abundant closing peritonium, even after the
Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,this is because it heals by iteslf quickly
Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,and so by not closing it it decreases postoperative pain and so it is preferred to not close the xxx
Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,once we are done with the closure of the uterine incision in two layers we have to make sure we don't have any bleeding
Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,don't leave any bleaders
Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,if there are any bleeding we have to do hemostatic sutures
Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,in those areas where we see bleeding
Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,we have to make sure we are controlled
Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,all the bleeding sites
Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,you can see now there are two bleeders
Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,that the surgeon is going to control using hemostatic sutures
Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,So once we are sure the bleeding has been controlled, we don't have any other procedure like tubal ligation
Dialogue: 0,9:59:59.99,9:59:59.99,Default,,0000,0000,0000,,we'll just return the uterus to the abdominal cavity