This document provides instructions for performing a non-descent vaginal hysterectomy (NDVH). It describes the necessary surgical instruments, patient positioning, examination under anesthesia, dissection techniques including opening the vaginal cuff and releasing the uterosacral ligaments, approaches for dealing with adhesions, and methods for confirming hemostasis after removing the uterus. The document also mentions volume reduction procedures that can be used for large uteruses and cauterizing or ligating blood vessels during the surgery.

1. Dr. Manik
Gurram

2. All hit sixes but
Mahi does it by unique way
Heliquopter shot
Is it easy
No
but withy practice other also
did it

4. Apart from routine instruments
Miegster Retractors Curved long clamp Bipolar forceps / scissor Bipolar
cautery Myoma screw Large uterine holding instrument having paw

5. Any gynecologist
who can insert speculum
catches cervix
and do
suction evacuation
Can do
NDVH
of normal size uterus

6. Extended lithatomy position with patients
buttocks coming out from edge of table
height of table such that speculum can be
easily inserted in vagina
it will be easy to do your hand movement in
neutral position
If very high very low its difficult to visualize
at same time
Your hands and assistant will be in pain after
procedure

7. After painting draping
Examination under anesthesia
is very important
Here descent is noted
Anterior adhesions
In a previous abdominal surgery
Whether uterus attached to
anterior abdominal wall is
confirmed by “uterine sound”
& abdomen movement
Posterior @ D.P.
Douglas pouch
Look for any dimples or
puckering

9. massage of uterosacrals by
index finger
Relaxes uterosacrals
and uterus slightly
descent down
aqua dissection
By
Normal Saline
Or adrenaline addition
Or vasopressin

10. Incise the anterior vaginal wall
at cervico vaginal junction
Above cervix with
Blade
No difficulty in non scared
uterus
1.Surgical window lateral to
uterine vessels
2.Posterior approach

11. 2 methods
1.In between two allies take
cut with scissors and open
upto peritoneum
2.Only open vagina insert
speculum
Then take care of lateral
pedicles
This is extra peritoneal
approach of uterine

12. Uterosacrals on both sides to
be released from uterus
By finger or clamp or bipolar
I prefer bipolar
at lateral aspect keep vagina
along with uterosacrals

13. In non scared uterus very easy
By traction and speculum below ant vaginal wall
it automatically opens uv space
In previous scared uterus
Just imagine
Lscs our scar in between uterines
So go lateral to uterus
Bu your finger dissect surgical window
which is most of times non adherent
And here we get utreries as tortuous vessels
either with elevation from below by migster Just cauterize vessel or
ligate

15. round ligament and infundibulopelvic
or ovarian
Again here vicryl for round ligament
Try to remove tubes this will give
practice to remove complete adenexa
If ovary be removed
use of round ligament anchor
Or with curved clamp
Confirm haemostasis after procedure

16. Volume reduction procdures
are required to remove big
uterus
Various methods
Coring
InvertedV incision
Myomectomy
Incision at various places

24. thanks