A Study of Scarless Surgery in Haryana (Non Descent Vaginal Hysterectomy)

Hysterectomy is one of the most common surgical procedures performed by the gynecologist. Historically, the uterus has been removed either by the abdominal or vaginal route. Non descent vaginal hysterectomy (NDVH) is an innovative highly qualitative procedure where the uterine mass without any descent in the vagina is exteriorized through the natural vaginal orifice resulting in affording an invisible scar. This paper aims at sharing our experience of 50 cases of non-descent vaginal hysterectomy on benign condition and exploring the safety and feasibility of non descent vaginal hysterectomy.

A hospital based prospective study was conducted from 1st March 2012 to 31st March 2014. Patients undergoing non descent vaginal hysterectomy for benign indications (DUB, leiomyoma, adenomyosis, PID etc) without prolapse, and without suspected adnexal pathology were taken for study. A total of 50 patients who met the above mentioned eligibility criteria were given informed consent and were consecutively included for the study. Prerequisites for non descent vaginal hysterectomy (NDVH) were set as uterine size not exceeding 20 weeks of gravid uterus (by clinical judgment), mild to moderate endometriosis, previous pelvic surgery or caesarean section and adequate vaginal access with good uterine mobility. Data regarding age, parity, preoperative hemoglobin level, indication for surgery, uterine size, duration of surgery, estimated blood loss at the time of surgery, whether blood transfusion was done in intra operative and post operative period, intra operative complications like bladder, ureter, bowel injury, conversion to abdominal hysterectomy if any were collected. Postoperative details like paralytic ileus, wound infection, length of analgesic usage and hospital stay after surgery were extracted from case sheets.

Non descent vaginal hysterectomy (NDVH) was successfully performed in 48 patients whereas 2 cases (4%) were converted to abdominal hysterectomy due to difficulty in opening pouch of Douglas (due to adhesion of endometriosis). The most common indication for NDVH was fibroid (46%), followed by DUB (24%). More than seventy percent of them had parity of two or more, and the median age was 43 years. Most of the patients (62%) had uterine size less than or equal to 10 weeks. Average operating time for uncomplicated cases was 45.5 minutes and average blood loss per case was 200ml. Most common post operative complication was pain in 8 cases followed by fever in 2 cases and vaginal infection in 1 case. Most of the patients were discharged by 3^rd post operative day.

The authors have no doubt to conclude that non descent vaginal hysterectomy is safe, feasible and patient friendly in most of the women requiring hysterectomy. An ideal goal for the gynecological surgeon should be to perform at least 3 out of 5 hysterectomies vaginally. Non descent vaginal hysterectomy for non prolapsed uterus should be practiced more frequently by gynecologists and should be included in training programs for residents and postgraduate trainees.