vaginal hysterectomies in large size uteri
TRANSCRIPT
![Page 1: Vaginal hysterectomies in large size uteri](https://reader033.vdocument.in/reader033/viewer/2022052508/559c16a31a28abc3428b457b/html5/thumbnails/1.jpg)
Dr Ashok Anand
Professor
Grant Government Medical College
Mumbai
Vaginal hysterectomies in
large size Uteri - our
experiences
![Page 2: Vaginal hysterectomies in large size uteri](https://reader033.vdocument.in/reader033/viewer/2022052508/559c16a31a28abc3428b457b/html5/thumbnails/2.jpg)
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
![Page 3: Vaginal hysterectomies in large size uteri](https://reader033.vdocument.in/reader033/viewer/2022052508/559c16a31a28abc3428b457b/html5/thumbnails/3.jpg)
First Abdominal hysterectomy
1825 Langenbeck ( Pt died )
1878 Freund Germany - First
modern transabdominal
Hysterectomy
![Page 4: Vaginal hysterectomies in large size uteri](https://reader033.vdocument.in/reader033/viewer/2022052508/559c16a31a28abc3428b457b/html5/thumbnails/4.jpg)
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
![Page 5: Vaginal hysterectomies in large size uteri](https://reader033.vdocument.in/reader033/viewer/2022052508/559c16a31a28abc3428b457b/html5/thumbnails/5.jpg)
Abdominal Surgeons delight
Laparoscopic Technological costly
surgery
Vaginal surgery Art of surgery
Medicine Art of science
Science of
technology
Trade &
Commerce
![Page 6: Vaginal hysterectomies in large size uteri](https://reader033.vdocument.in/reader033/viewer/2022052508/559c16a31a28abc3428b457b/html5/thumbnails/6.jpg)
Today’s contraindications
Tomorrow’s indications.
![Page 7: Vaginal hysterectomies in large size uteri](https://reader033.vdocument.in/reader033/viewer/2022052508/559c16a31a28abc3428b457b/html5/thumbnails/7.jpg)
More than half million hysterectomies are
performed every year
1:3 above age of 60
![Page 8: Vaginal hysterectomies in large size uteri](https://reader033.vdocument.in/reader033/viewer/2022052508/559c16a31a28abc3428b457b/html5/thumbnails/8.jpg)
Vaginal Hysterectomy
Total Abdominal Hysterectomy
Total Vaginal Hysterectomy
Laparoscopically Assisted Vaginal Hysterectomy
Laparoscopic supracervical hysterectomy
Total Laparoscopic hysterectomy
Minimal invasive Vaginal Hysterectomy.
![Page 9: Vaginal hysterectomies in large size uteri](https://reader033.vdocument.in/reader033/viewer/2022052508/559c16a31a28abc3428b457b/html5/thumbnails/9.jpg)
Vaginal Hysterectomy
Scar less
Painless
Bloodless
Less expensive, cost effective
Less complications less morbidity
Less hospital stay
Good for Obese high risk patient
![Page 10: Vaginal hysterectomies in large size uteri](https://reader033.vdocument.in/reader033/viewer/2022052508/559c16a31a28abc3428b457b/html5/thumbnails/10.jpg)
Downward mobility
Size ???
Adequate fornixes
Healthy tissues
Assessment in lithotomy position under
anaesthesia.
![Page 11: Vaginal hysterectomies in large size uteri](https://reader033.vdocument.in/reader033/viewer/2022052508/559c16a31a28abc3428b457b/html5/thumbnails/11.jpg)
Large Uterus
Bisection
Myomectomy
Volume reduction
Perineal incision
![Page 12: Vaginal hysterectomies in large size uteri](https://reader033.vdocument.in/reader033/viewer/2022052508/559c16a31a28abc3428b457b/html5/thumbnails/12.jpg)
![Page 13: Vaginal hysterectomies in large size uteri](https://reader033.vdocument.in/reader033/viewer/2022052508/559c16a31a28abc3428b457b/html5/thumbnails/13.jpg)
![Page 14: Vaginal hysterectomies in large size uteri](https://reader033.vdocument.in/reader033/viewer/2022052508/559c16a31a28abc3428b457b/html5/thumbnails/14.jpg)
![Page 15: Vaginal hysterectomies in large size uteri](https://reader033.vdocument.in/reader033/viewer/2022052508/559c16a31a28abc3428b457b/html5/thumbnails/15.jpg)
![Page 16: Vaginal hysterectomies in large size uteri](https://reader033.vdocument.in/reader033/viewer/2022052508/559c16a31a28abc3428b457b/html5/thumbnails/16.jpg)
![Page 17: Vaginal hysterectomies in large size uteri](https://reader033.vdocument.in/reader033/viewer/2022052508/559c16a31a28abc3428b457b/html5/thumbnails/17.jpg)
![Page 18: Vaginal hysterectomies in large size uteri](https://reader033.vdocument.in/reader033/viewer/2022052508/559c16a31a28abc3428b457b/html5/thumbnails/18.jpg)
![Page 19: Vaginal hysterectomies in large size uteri](https://reader033.vdocument.in/reader033/viewer/2022052508/559c16a31a28abc3428b457b/html5/thumbnails/19.jpg)
![Page 20: Vaginal hysterectomies in large size uteri](https://reader033.vdocument.in/reader033/viewer/2022052508/559c16a31a28abc3428b457b/html5/thumbnails/20.jpg)
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
![Page 21: Vaginal hysterectomies in large size uteri](https://reader033.vdocument.in/reader033/viewer/2022052508/559c16a31a28abc3428b457b/html5/thumbnails/21.jpg)
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
![Page 22: Vaginal hysterectomies in large size uteri](https://reader033.vdocument.in/reader033/viewer/2022052508/559c16a31a28abc3428b457b/html5/thumbnails/22.jpg)
![Page 23: Vaginal hysterectomies in large size uteri](https://reader033.vdocument.in/reader033/viewer/2022052508/559c16a31a28abc3428b457b/html5/thumbnails/23.jpg)
![Page 24: Vaginal hysterectomies in large size uteri](https://reader033.vdocument.in/reader033/viewer/2022052508/559c16a31a28abc3428b457b/html5/thumbnails/24.jpg)
![Page 25: Vaginal hysterectomies in large size uteri](https://reader033.vdocument.in/reader033/viewer/2022052508/559c16a31a28abc3428b457b/html5/thumbnails/25.jpg)
![Page 26: Vaginal hysterectomies in large size uteri](https://reader033.vdocument.in/reader033/viewer/2022052508/559c16a31a28abc3428b457b/html5/thumbnails/26.jpg)
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.
![Page 27: Vaginal hysterectomies in large size uteri](https://reader033.vdocument.in/reader033/viewer/2022052508/559c16a31a28abc3428b457b/html5/thumbnails/27.jpg)
Technological change is like
an AXE in the hands of
pathological criminal
Albert
Einstein
![Page 28: Vaginal hysterectomies in large size uteri](https://reader033.vdocument.in/reader033/viewer/2022052508/559c16a31a28abc3428b457b/html5/thumbnails/28.jpg)
Thank You