Chapters Transcript Robotic Hysterectomy Utilizing NuShield: Dr. Manuel Penalver, MD Dr. Manuel Penalver’s Robotic Hysterectomy case utilizing NuShield as a protective, surgical barrier. Good morning. I'm Doctor Manuel Penalver. I am a gynecologic oncologist at the Larkin Hospital, Palm Springs, uh, in Hialeah, Florida, and, uh, this is a patient that was referred to us with a diagnosis of cervical cancer. We have performed a robotic hysterectomy, bilateral salpingo oophorectomy with pelvic and perortic lymphadenectomy, and this will be sent for pathologic evaluation. The hysterectomy part is done. The lymphadenectomy part is done, and now we're going to illustrate the use of NuShield. One of the problems that we have had over the years is that after we do a hysterectomy, the pelvic floor remains a rough surface, and the bowel can adhere. To the rough surface and in some cases even bowel obstruction, and the patient requires another surgery to fix the bowel obstruction. We place a very, very smooth new shield membrane. We have been using it for over 2 to 3 years now with excellent results. I have not brought back any patients for bowel obstruction. And I would like to illustrate exactly how we do it now. Before I do that, I would like to introduce to you my team. My partner is Doctor Michael Alpizer, also a gynecologic, uh, oncologist who helps me with, uh, all the surgeries. Uh, I have also Tony who is the scrub tech. Excellent. Hanni is my assistant. I have excellent, uh, health. Uh, Daniela is an anesthesia. Johann is in charge of the, uh, uh, nursing, uh, and the, and the, and the, uh, room. Um, operations here, so I would like to illustrate now how we use the membrane and Tony will be handing the, uh, membrane to Doctor, uh, Alpizar. Doctor Alpizar will introduce the membrane to me through the trocars, and I will be able to illustrate to you and show you exactly how we place it in the pelvic floor. Remember, the purpose of this is so that the bowel does not look. At a rough surface in the pelvic floor that the bowel looks at a very, very smooth surface which is the way it is before surgery and the bowel cannot adhere to the rough area so what we're gonna try to do now is to uh illustrate how exactly we place it it's like a buffer between the rough pelvic floor and the bowel so we're gonna go ahead and illustrate the surgical technique now. What I wanna do guys is I wanna put the shield over the rough surface. OK, so what's happening here is that Doctor Alpiso and Tony and uh have passed to me the new shield through the trochar. I have the new shield right here as you can see, which is a very, very smooth surface, and I'm going to show you this for a second because I want to show how rough the pelvic floor looks after a hysterectomy, bilateral salping oophorectomy, and a lymphadenectomy. You do not want the bowel to be facing this because. What it will do is we'll be adhering to that. So what I'm going to present is a very, very smooth surface so that the bowel instead of looking at the rough area is looking at a very, very nice smooth surface as you can see right here, see. And you can see how nice, how, how smooth you can move it around to cover all the rough areas that you want. This will, uh, epithelialize over here and this is what the bowel will be looking at right now. We're going to also introduce here now a hemostatic material that we use to, uh, uh, in case there's any small bleeders like this or anything like that to to. You know, to promote hemostasis to prevent uh bleeding, but again, the whole purpose of this, this is the way it was before the surgery. Look how smooth this is what the bowel used to look at we open this up, it stays a very, very rough area, so what the membrane does is that it presents now a very smooth surface when the bowel adheres here, it's adhering to a very smooth surface, not the rough surface after surgery. And again we have been using this for over 2 years with excellent results. Thank you very much. Published June 9, 2026 Created by
