1. Dr Ashok Anand
Professor
Grant Government Medical College
Mumbai
Vaginal hysterectomies in
large size Uteri - our
experiences

2. 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

3.  First Abdominal hysterectomy
 1825 Langenbeck ( Pt died )
 1878 Freund Germany - First
modern transabdominal
Hysterectomy

4.  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

5.  Abdominal Surgeons delight
 Laparoscopic Technological costly
surgery
 Vaginal surgery Art of surgery
 Medicine Art of science
Science of
technology
Trade &
Commerce

6. Today’s contraindications
Tomorrow’s indications.

7.  More than half million hysterectomies are
performed every year
 1:3 above age of 60

8. Vaginal Hysterectomy
Total Abdominal Hysterectomy
Total Vaginal Hysterectomy
Laparoscopically Assisted Vaginal Hysterectomy
Laparoscopic supracervical hysterectomy
Total Laparoscopic hysterectomy
Minimal invasive Vaginal Hysterectomy.

9. Vaginal Hysterectomy
 Scar less
 Painless
 Bloodless
 Less expensive, cost effective
 Less complications less morbidity
 Less hospital stay
 Good for Obese high risk patient

10.  Downward mobility
 Size ???
 Adequate fornixes
 Healthy tissues
 Assessment in lithotomy position under
anaesthesia.

11. Large Uterus
 Bisection
 Myomectomy
 Volume reduction
 Perineal incision

20. Observations
 Duration of study 2
years
 No. of Hysterectomies
165
 Abdominal
58
 Vaginal
44
 Non Descent Vaginal
63
 More than 12 weeks size uterus

21. 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

26. 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.

27. Technological change is like
an AXE in the hands of
pathological criminal
Albert
Einstein

28. Thank You