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NON DESCENT VAGINAL HYSTERECTOMY    ----


A SAFER APPROACH IN HIGH RISK CASES:


Introduction:


Hysterectomy is one of the common gynecological surgery performed through abdominal/ vaginal /laparoscopic routes. Vaginal techniques have been practiced for centuries, but has been outdated  especially in recent years after the fancy  invention of Laparoscopic hysterectomies. This is due to lack of experience and enthusiasm among evolving gynecologist and due to misconception that abdomen route is safer and easier.




  • Vaginal route is the least invasive route of all, utilizing a naturally existing anatomical orifice .

  • The ease and convenience offered by a an abdominal incision have led to the preponderance of abdominal hysterectomies.

  • However proper selection of patient is a critical factor is determining the success of vaginal procedures.

  • Lack of expertise and curve  in learning the technique has major impact on choosing the route of hysterectomies.

  • In our center hysterectomy is performed by Laparoscopic, Abdominal and vaginal routes.

  • However we prefer the later route as we find it less time consuming and cost effective for patients.


CASE DISCUSSION - I:

 48years Mrs. S , Heavy menstrual bleeding -6 years,  Fibroid uterus - Intra manual fibroid with Adenomyosis.  

  • Patient was a K/C/O systemic Lupus erythematosus on immunosuppressants. 

  • With H/O lung involvement four years back for which she underwent tracheostomy.

  • She had several risk factors like hypertension, Renal impairment secondary to SLE/morbid obesity.

  • We opted for trial vaginal Hysterectomy as even Laparoscopic on abdominal route was risky often this patient.

  • Patient underwent vaginal Hysterectomy with multi disciplinary perioperative case and was discharged 4 th post operative day.   





CASE DISCUSSION - II:

44 years Mrs. X, A P2L2  / Sterilised.

  • K/C/ - Fibroid Uterus, submucosal with 3cm fibroid polyp protruding through the os.

  • With C/O - Heavy menstrual bleeding and pain 1yrs. 

  • P/V - Uterus 12week mobile, VTT positive. Underwent vaginal Hysterectomy for non descent Uterus.

  • Patient discharged on II POD. 











DISCUSSION - DOCTORS CORNER:


  • NDVH is an Passion of Gynec Surgeon.

  • Vaginal route is the safest and most cost effective route because of shorter hospital stay,

  • No visible scar .

  • No risk of General Anesthesia hence  can be used in cases with Cardio Pulmonary complications  where Laparoscopic route  is difficult.

  • More time Saving is experienced hands. Laparoscopic route is associated with increased operating times and risk injuries.

  • Quick recovery and early discharge.

  • Using single clamps is easier in difficulty cases with decreased space.

  • Using straight needle prevents lateral injury.

  • Aqua dissection might reduce blood loss.

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