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.
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.
8.
9. Anaesthesia: Combined spinal-epidural
Position: Dorsal lithotomy
Drapping and painting with betadine
Labial sutures
Metal catheterisation
10.
11.
12.
13.
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.
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
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