This document discusses different types of hysterectomies including vaginal hysterectomy (VH), laparoscopic assisted vaginal hysterectomy (LAVH), total laparoscopic hysterectomy (TLH), and abdominal hysterectomy (AH). It summarizes various studies that show rates of different hysterectomy methods varying between countries and over time. For example, one UK study from 1998 found AH was performed 74% of the time while a US study from around the same time found VH was performed 89% of the time. The document concludes that while LAVH may be appealing, it should not replace VH when VH is possible, and the overall aim should be to decrease rates of morbid AH procedures worldwide.

2. “ DR. MANJUSHREE BOOB”
M.B.B.S. M.D. D.N.B. F.I.C.M.C.H.
DIPLOMATE OF NATIONAL BOARDS
FELLOW GUIDE FOR DAWN DGO’S COURSES
“SHUBHAM HOSPITAL”
BADNERA ROAD
AMRAVATI [ M.S. ]
By,…By,…
Non-descent vaginal hysterctomy

3. INCIDENCE OF TAH, VH, LAVH
VALUE STUDY 1998 [ U. K. ]
[ Vaginal, Abdominal And Laparoscopic Uterine
Extirpation ]
Abdominal - 74%
Vaginal - 18.4%
Laparoscopic hysterectomy - 7.6% } 1995
U.S.A. STUDY BY KOVACK
Vaginal - 89%
Abdominal - 11%

4. Total Cases - 9095
Abdominal - 93% in 1990
Vaginal - 7%
FINLAND STUDY
While study in 1995 has shown rise in Vaginal hysterectomy
cases.
AUSTRALIAN STUDY
Abdominal route was more preferred up to 90%
DR. SETH’S SIR’S STUDY- INDIA :
Total 5985 cases
Vaginal - 80%
IN THIS NEW MILLENIUM
“ Advent of Laparoscopic surgery has revived and
increased the of incidence of VH tremendously in World

5. SELECT MOST SAFE AND MINIMALLY INVASIVE.
THREE MODES TO REMOVE UTERUS -
UTERINE EXTIRPATION => PLACE OF VARIOUS
ROUTESWHICH ROUTE ??? TO SELECT

6. TLH
[ Ultra Modern Surgery ]
Abdominal Hystectomy
[ AN OLD ART- NEED TO DECREASE THIS MORBID
SURGERY ]

8. COMPLICATIONS :
Morbidity
1. Interaoperative—
a. Urinary Bladder injury
b. Bowel injury
c. Collateral vessal injury ( near the Cloquet’s
lymph node)
2. Immediate Postoperative--
i) Surgical a. Haemoperitoneum
b. Vesicovaginal fistula
c. Ureteral injury
d. Postoperative vault induration ( small
haematoma)
ii) Medical a. Postoperative pyrexia of unknown origin
b. Urinary tract infection
c. ARDS
d. Deep vein thrombosis
Mortality 1. Medical or Unexplained ( Chronic anemia with

9. COMPARISION OF VAGINAL VERSUS LAPROSCOPIC VERSUS ABDOMINAL
HYSTERECTOMY
Vaginal Hysterectomy Laparoscopic
Hysterectomy
Abdominal
Hysterectomy
Regional Anesthesia General Anesthesia General Anesthesia
4 Week Convalescence 4 Week Convalescence 8 Week Convalescence
1 Night in the Hospital 1-2 Nights in the Hospital 2-3 Nights in the
Hospital
Internal Incisions Only Internal & External
Incisions
External & Internal
Incisions
No Abdominal Scars 4 Small Abdominal Scars Large Abdominal Scar
Lowest Complication
Rate
Highest Complication Rate Average Complication
Rate
Less Expensive More Expensive More Expensive
Highest Surgical Skill
Required
Moderate Surgical Skill
Required
Least Surgical Skill
Required

10. At last commenting on place of NDVH Today,
any procedure should have following A’s to be
popular amongst patient and doctors
1. Available
2. Affordable
3. Acceptable
4. Accessible
5. Adaptable
6. Artifice Ease
7. Aquantible
8. Acquisible
9. Admirable

11. “ Look on this procedure with WONDER, Love
this procedure and Enhance the learning skill
for NDVH And I assure,
“ALL THE NOVICE GYNAECOLOGIST CAN DO
IT IF ALL A’S PUT TOGETHER”

12. CONCLUSION:
LAPAROSCOPIC HYSTERECTOMY is glamorized more
than its actual scientific value. Laparoscopic
Hysterectomy should not be taken only for glitter or
glamour specially in cases were vaginal hysterectomy
is possible, So LAVH should be done where VH is
contraindicated and main aim is to the decrease the
incidence of morbid AH World wide.

13. INDEBTED TO ONE AND ALL
FOR
PATIENT LISTENING