Though time should not be the factor while doing any surgery,morbidity and blood loss does go up with the prolonged operating time.Same holds true for vaginal hysterectomy.I remember when I did my first few hysterectomies during the residency,I took almost 2- 2.30 hrs ,with a few requiring blood transfusions.Well surgical technique have since then come up by quite a good measure,.Again I would list some dos and dont do’s to speed up your time for vaginal hysterectomy.
1) Would again recommend using hydrodissection technique,as I have mentioned in the previous blogs
2) Adjust the height of the table according to the comfort of the assistant ,so that he/she does not have to bend too much.
3) Needless to stress the importance of proper light and good quality basic instruments
4) Do not make a clutter of too many retractors,mere anterior and a big size posterior vaginal retractor is enough,one can just adjust their position as per the need of a particular step.
5) I do not cut the lateral vaginal wall but retain its attachment with the uterosacral ligaments,s o that the the ligament retains its natural attachment to the vault and saves the time and effort to close it after the surgery.
6) Do not waste time in going after the Anterior pouch,just push or dissect the bladder up and secure it under the anterior wall Landens retractor,The Anterior pouch will open up on its own as one goes up,after securing the uterine arteries.
7)If the size of uterus is big or descent poor,use any debulking technique,or a vaginal myoma screw.
8) No need to close the peritoneum after the uterus is removed.
9) Use a good delayed absorbable suture,with proper surgical knots.
Using some of these modifications one can cut short the time to a great extent so much so that an average hysterectomy can get over in 30 to 45 mins.
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