Non descent vaginal hysterectomy

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Non descent vaginal hysterectomy

  1. 1. Speaker: Dr Rajni Singh Moderater: H.O.D & Prof. Dr. S .Dasgupta BANKURA SAMMILANI MEDICAL COLLEGE 19/03/2014
  2. 2.  Evolving passion of gynae surgeon among vaginal hysterectomy  Performed for causes other than prolapse
  3. 3.  Langenbeck first performed vaginal hysterectomy in 1813 .  Nondescent Vaginal Hysterectomy pioneered by Haene’yin 1934
  4. 4.  Vaginal Hysterectomy is the safest and most cost-effective route.  Less complication,fast recovery with short hospital stay.  Without any visible scar.
  5. 5.  Dysfunctinal uterine bleeding  Fibroid uterus  Adenomyosis  Chronic pelvic pain  Post menopausal bleeding  Pyometra  Cervical dysplasia  Cervical polyp
  6. 6.  Uterus more than 20 wks size  Adnexal pathology  Limited vaginal space  Restricted uterine mobility  Cervix flushed with wall  Previous history of fistula(VVF/RVF) repair
  7. 7. Evaluation of Pelvic Support: Uterine mobility Evaluation of the Pelvis:  Angle of the pubic arch:- 90 degrees/greater,  Descent of cervix,  Mobility of vaginal mucosa,  Vaginal canal should be ample,  Posterior vaginal fornix should be wide and deep.
  8. 8.  Anaesthesia: Combined spinal-epidural  Position: Dorsal lithotomy  Drapping and painting with betadine  Labial sutures  Metal catheterisation
  9. 9.  Posterior cul-de-sac should be open first.  Anterior cul-de-sac: i. Bladder separated with sharp dissection ii. Mayo curved scissors tips are pointed downward( 30° angle to the plane of the cervix) iii. Lateral window may be used.
  10. 10.  Vaginal pack with betadine  Foley catheterisation
  11. 11. 40 MM HALF CIRCLE SRS NEEDLE  Techniqualy difficult  Incraesed chances of injury  Difficult to handle needle  Movement easy  Less injury to lateral structure  Easy to handle needle
  12. 12. 1. direct suturing of ligaments and cutting. 2. Suitable to work in less space. 3. Broad ligament structures are tied in 3 parts 4. Bloodless procedure
  13. 13. 1. Simplifies vaginal hysterectomy 2. Make it bloodless 3. Made bladder dissection easy PRINCIPLE :-tissue beneath the mucosa is flooded with fluid,compresses the vascular plane (fluid tourniquet) NS with/without adr is used for this
  14. 14.  Newer hemostatic systems include 1. Laser 2. High frequency electrosurgery 3. Utrasonic (limited for vessels upto 2mm)  LIGASURE vessel sealing system:-  combination of pressure and bipolar electrical energy  Seal vessels upto 7mm
  15. 15.  Bivalving/bisection  Morcellation  Myomectomy  Intramyometrial coring
  16. 16. BISECTION
  17. 17.  Routine prophylactic antibiotic, anti emetic (Ondansetron), Ranitidine  IV fluid 12 hours,  Oral fluid after 3 hours,  Catheter removal after 12 hours,  Vaginal drain/betadine gauge removal after 6-8 hours,  Solid diet after 12 hours,  Analgesic for minimum 12 hours then if needed.  Patient can go home after 24-36 hours of operation
  18. 18.  Urinary tract injury  Bowel Injury  Hemorrhage
  19. 19.  Vault hematoma  Vaginal discharge  Wound Infections  Hemorrhage  Urinary Tract Complications 1. Urinary Retention 2. Ureteral Injury- flank pain d/t ureteral obstruction 3. Vesicovaginal Fistula
  20. 20. THANK YOU
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