Many patients undergoing total abdominal hysterectomy and laparoscopically assisted vaginal hysterectomy could probably undergo total vaginal hysterectomy instead. Despite the advantages of lower morbidity and faster recovery, very few hysterectomies are performed by the vaginal route, although there is a high feasibility rate. Vaginal hysterectomy can be more complex and gynecologists need to be familiar with surgical techniques. Many surgeons might not feel comfortable with the vaginal route particularly where relative contraindications exist (e.g. large uterus, nulliparity, inadequate access, previous cesarean delivery pelvic laparotomy and if oophorectomy is required).
Dr R. K. Purohit, Department of Obstetrics and Gynaecology, Purohit General Hospital, Orissa, has developed a technique known as 'the Purohit technique of vaginal hysterectomy' to ease intra-operative access to laterally at vaginal hysterectomy. In a prospective study on consecutive 214 women with benign disease of the uterus without prolapse, including cases with relative contraindications, the technique was demonstrated to be easy, safe and effective. Vaginal hysterectomy was successfully completed in 99.53% cases, with one failure, which needed laparoscopic assistance.
The author, writing in the December issue of BJOG: An International Journal of Obstetrics and Gynaecology, says that he believes that many abdominal and laparoscopic hysterectomies could be avoided by this technique. The technique of vaginal hysterectomy is reported to be feasible, safe and effective in conducting vaginal hysterectomy in almost all cases of benign disease.
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