vaginal hysterectomies in large size uteri
TRANSCRIPT
Dr Ashok Anand
Professor
Grant Government Medical College
Mumbai
Vaginal hysterectomies in
large size Uteri - our
experiences
First Vaginal Hysterectomy 500 BC Hyppocrates
Procedentia.
1600 Schenk Presented first series of 26
cases.
1813 Langenback Hysterectomy for Uterine
Carcinoma.
1846 First Modern vaginal hysterectomy by
Heaney
First Abdominal hysterectomy
1825 Langenbeck ( Pt died )
1878 Freund Germany - First
modern transabdominal
Hysterectomy
Up to 1980 s Age of Gynaecological
surgery
1980 to 1990 Age of Abdominal surgery
1990 –to- 2005 Age of laparoscopic
surgery
2005 onwards ? Robotic
Abdominal Surgeons delight
Laparoscopic Technological costly
surgery
Vaginal surgery Art of surgery
Medicine Art of science
Science of
technology
Trade &
Commerce
Today’s contraindications
Tomorrow’s indications.
More than half million hysterectomies are
performed every year
1:3 above age of 60
Vaginal Hysterectomy
Total Abdominal Hysterectomy
Total Vaginal Hysterectomy
Laparoscopically Assisted Vaginal Hysterectomy
Laparoscopic supracervical hysterectomy
Total Laparoscopic hysterectomy
Minimal invasive Vaginal Hysterectomy.
Vaginal Hysterectomy
Scar less
Painless
Bloodless
Less expensive, cost effective
Less complications less morbidity
Less hospital stay
Good for Obese high risk patient
Downward mobility
Size ???
Adequate fornixes
Healthy tissues
Assessment in lithotomy position under
anaesthesia.
Large Uterus
Bisection
Myomectomy
Volume reduction
Perineal incision
Observations
Duration of study 2
years
No. of Hysterectomies
165
Abdominal
58
Vaginal
44
Non Descent Vaginal
63
More than 12 weeks size uterus
38
Abdominal
Vaginal
Blood loss 150-200 cc 50-
100cc
Operative time 1.5-2hr
45min-1hr15min
Bladder injury Nil Nil
Bowel/ Ureteric Injury Nil Nil
Post op Bleeding Nil 2
Wound dehiscence 6
Nil
Post operative Analgesics All for longer
Shorter time
Ambulation Late
Early
Conclusions
Every uterus can be removed vaginally
Start doing whatever is necessary then
whatever is possible
Impossible itself says “I M Possible”
We are Vaginal Surgeons let us practice
the ART of Vaginal Surgery.
Let us not become Technological giants &
moral Pigmies.
Technological change is like
an AXE in the hands of
pathological criminal
Albert
Einstein
Thank You