1. Speaker: Dr Rajni Singh
Moderater: H.O.D & Prof. Dr. S .Dasgupta
BANKURA SAMMILANI MEDICAL COLLEGE
19/03/2014

2.  Evolving passion of gynae surgeon among vaginal
hysterectomy
 Performed for causes other than prolapse

3.  Langenbeck first performed vaginal
hysterectomy in 1813 .
 Nondescent Vaginal Hysterectomy pioneered
by Haene’yin 1934

4.  Vaginal Hysterectomy is the safest and most
cost-effective route.
 Less complication,fast recovery with short
hospital stay.
 Without any visible scar.

5.  Dysfunctinal uterine bleeding
 Fibroid uterus
 Adenomyosis
 Chronic pelvic pain
 Post menopausal bleeding
 Pyometra
 Cervical dysplasia
 Cervical polyp

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. 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.

9.  Anaesthesia: Combined spinal-epidural
 Position: Dorsal lithotomy
 Drapping and painting with betadine
 Labial sutures
 Metal catheterisation

14.  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.

24.  Vaginal pack with betadine
 Foley catheterisation

27. 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

28. 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

29. 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

30.  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

32.  Bivalving/bisection
 Morcellation
 Myomectomy
 Intramyometrial coring

34. BISECTION

36.  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

38.  Urinary tract injury
 Bowel Injury
 Hemorrhage

39.  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

40. THANK
YOU