Dr Ashok Anand

Professor

Grant Government Medical College

Mumbai

Vaginal hysterectomies in

large size Uteri - our

experiences

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

Heaney

First Abdominal hysterectomy

1825 Langenbeck ( Pt died )

1878 Freund Germany - First

modern transabdominal

Hysterectomy

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

Abdominal Surgeons delight

Laparoscopic Technological costly

surgery

Vaginal surgery Art of surgery

Medicine Art of science

Science of

technology

Trade &

Commerce

Today’s contraindications

Tomorrow’s indications.

More than half million hysterectomies are

performed every year

1:3 above age of 60

Vaginal Hysterectomy

Total Abdominal Hysterectomy

Total Vaginal Hysterectomy

Laparoscopically Assisted Vaginal Hysterectomy

Laparoscopic supracervical hysterectomy

Total Laparoscopic hysterectomy

Minimal invasive Vaginal Hysterectomy.

Vaginal Hysterectomy

Scar less

Painless

Bloodless

Less expensive, cost effective

Less complications less morbidity

Less hospital stay

Good for Obese high risk patient

Downward mobility

Size ???

Adequate fornixes

Healthy tissues

Assessment in lithotomy position under

anaesthesia.

Large Uterus

Bisection

Myomectomy

Volume reduction

Perineal incision

Observations

Duration of study 2

years

No. of Hysterectomies

165

Abdominal

58

Vaginal

44

Non Descent Vaginal

63

More than 12 weeks size uterus

38

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

Early

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.

Technological change is like

an AXE in the hands of

pathological criminal

Albert

Einstein

Thank You