The basic principle of any surgical technique is to make it simple and more importantly bloodless. It’s a widespread belief that vaginal hysterectomy leads to a significant blood loss during surgery. However with the hydro dissection (aqua dissection) technique the blood loss during the surgery can be brought down to negligible.
In this technique we infiltrate about 150 to 250 ml of saline, with or without adrenaline or vasopressin, the drugs which cause vasoconstriction. (I personally add 2-3 drops of adrenaline with a 20 gauge needle in 200 ml of saline, lest there is an absolute contraindication like severe hypertension or previous myocardial infarction). This saline is infiltrated under pressure with a no. 16 or 18 gauge needle, all around the cervix, just under the vaginal mucosa (skin of the vagina). Only about half a centimeter of the needle should go under the mucosa.
This technique works by two principles. First it serves as a tourniquet, so that all oozing small blood vessels are compressed and automatically the blood loss is prevented. Secondly it is easy to get the planes of dissection and that simplifies the surgery.
There are no complications or side effects of this technique. One of the fears which have been put forth in front of me is whether this will cause tissue necrosis?
I feel this is an unfounded fear and I have never encountered any tissue necrosis.
So to conclude hydro-dissection technique makes the art of vaginal hysterectomy simple, fast, and bloodless.
In my own experience there is hardly a blood loss of 5ml to a maximum of 10 ml. during the course of entire surgery.
