With some technical modifications in the traditionally taught steps of the vaginal hysterectomies,we can make the procedure simpler and faster.
1) One can use hydrodissection technique as described in the previous blog
2) Dont go after opening the anterior fold of peritoneum,just retract the bladder under some retracter and go on applying the clamps. The A pouch will open up on its own after we take the uterines ,except in cases of previous LSCS where I prefer opening the pouch after ligating the uterines.
3) I dont cut the lateral vaginal wall but retain its attachment with the uterosacrals,so that the part of the vault retains its natural attachment with the ligament.
4) I anchor the uterosacrals to the vault right in the beginning by taking the long end of the suture through the posterior edge of the vagina.
5) Always take an additional pedicle of the round ligament with the ascending branch of the uterine. This simplifies the approach to the infundibulopelvic ligament and takes care of the chances of bleeding in the post op period.
5) One should use the morcellation technique i.e bisection,transection,coring ,to debulk the uterus for easy delivery
6) Vaginal Myoma screw is a very handy instrument to apply traction to deliver a fibroid or a uterus
7) Always secure the vaginal angles securely as they the most notorious oozers in the post op period.
Posts Tagged ‘Vaginal Hysterectomy’
vaginal Hysterectomy : The steps simplified
November 25, 2010The Basics – When is Hysterectomy needed?
July 20, 2009Over the next few blogs, I want to talk about the area of my work/specialization and what it means. If you have read my introduction in my “About Me” page, you would have read that one of my specialization is what the medical fraternity refers to as “Vaginal Hysterectomy“. One blog may not be sufficient to describe this procedure in its entirety, so I have decided to break it into parts. As is with the case of describing any procedure, in this blog let me cover the basics.
Gynecological problems (listed below) faced by womenfolk can be distressing and many a times detrimental to health. Typically the initial treatment for many of these conditions is medicine-oriented. However when that does not work, then surgical treatment i.e. in this case removal of the uterus is advisable. With few exceptions, any woman who is beyond 35 years of age and is suffering from any of the following ailments, the advisable procedure is Hysterectomy. There is plenty of literature on Hysterectomy available on the internet which I typically advise my patients to read if they have access to it. However, if I were to summarize about when Hysterectomy is needed – here are some of the initial high level symptoms (covering the causes behind these symptoms may be a side track on this topic. I will cover it if there is any interest from the readers) -
- Fibroid (lump) in/on the uterus which is leading to short menstrual cycles or heavy flow during the menses.
- Heavy bleeding during the menstrual cycles (with or without passage of clots) which does not respond to any medical therapy or curetting. This is also referred to as D&C. Think about curetting as a medical procedure in which the inside contents of uterus is scraped. Why curetting is needed is a topic of another discussion.
- Persistent white discharge at times associated with inflammation around the uterus, again which does not respond to drugs.
- Prolapse of Uterus – The uterus is held in position by adequate support of the muscular structures of vagina and all other local tissues and muscles (also referred to as utrine support). However, because of the laxity of this support system – the uterus does Prolapse i.e. it feels like it is descending out and remains outside the vagina.
- Any persistent ulcer or nodule over the cervix visualized during the pervaginal examination (this needs to be evaluated first by taking a simple smear like Pap smear or biopsy to find the exact pathology, before planning a surgery)
More than 1 in 3 women in India typically going through the causes listed above. While Hysterectomy is a common procedure, the important aspect is to figure out what are the procedures/options in it and what are the benefits and risks associated with that. In my future blogs, I will try to cover the following two topics -
- What are the different routes available for Hysterectomy?
- What are the frequently asked questions/inihibitions about Hysterectomy which I have heard or seen from my patients?
I will be back soon with my future blogs.
On to the Blogging World…
July 10, 2009After a long pending wish, I have finally logged on the blogging world. I look forward to using this medium to communicate with you all out there.
Before I get going, I hope you got a chance to read about who I am in my “About Me” page. As a practicing Gynacelogist with a specialization in Vaginal Hysterectomy, High Risk Pregnancies, and Critical Care in Obstetrics – some of you might find my starting to blog a bit out of the way. However, over the years as part of my experience, I have learnt that exchanging information in my area of medicine goes a long way.
While interacting with women as part of my profession (especially the ones who are ‘medically’ suffering) – especially in my part of the world – a thought resoundingly keeps coming to my mind. “if only they had known…”. I am of a strong belief that knowledge and awareness is fundamental to the core of proper healthcare. Quite a while back, my brother – Manish Rathi – had introduced me to this empowering concept called as “Blogging”. Now, I have decided to take a plunge into it. I am hoping that the purpose of my blog would be to interact with others on the topics which are near and dear to me. While doing so – I hope I can learn from other’s experiences and some of you find some thing to take away from my experiences too.
Beyond just my field and area of expertise, I also reflect a lot on the state (both good and bad) of healthcare in a generic manner in India. Like almost all of you, I also have an extended friends and family circle and they share their medical-related thoughts, experiences and wishlists – both good and bad. And I see and hear a lot of things which I can certainly summarize as the important issues which typical families in India are thinking about related to healthcare – many of them from a patient perspective. I hope to touch upon those topics too in my blog going forward – more from a medical professional perspective.
As part of this medium, I would always welcome the opportunity of interacting with you all. Add a comment/feedback on my blog and I will try to respond to it there. If you wish to correspond with me through my email – it is mentioned on “About Me” page.
Until the next post…
