Background: Vaginal hysterectomies have been associated with difficulties in patients who have had cesarean sections prior to such hysterectomies. However, the Purohit technique may obviate the problems and make it easier to perform these operations. Objectives: This research tested an approach designed to facilitate vaginal hysterectomy in patients with previous cesarean sections in the absence of fixed adhesions of uterine corpi to previous anterior abdominal scarring. Design/Method: An observational study was conducted in a private general hospital between February 2010 and June 2012. All candidates for hysterectomy for benign indications who had had previous cesarean sections were examined for the presence of clinical and sonographic signs of fixed adhesions of uterine corpi to anterior abdominal-wall incisions caused by prior cesarean sections. Candidates who had such adhesions were not given vaginal hysterectomies. Results: Sixty-four (64) consecutive candidates were selected for vaginal hysterectomies. Of these patients, 26 (40.62%) had 1 cesarean section, 33 (51.56 %) had 2 cesarean sections, and 5 (7.81%) had 3 cesarean sections. Four (4) patients had had prior pelvic operations. The uteri were smaller than 12 weeks' gestationsize in 62 (96.87%) cases. In 26 (40.62 %) cases, there were no obstruction to accessing the anterior cul-de-sacs and vaginal hysterectomies were performed using the Purohit technique. In 38 (59.37 %) cases, dense uterovesical adhesions obstructed access to the anterior cul-de-sacs and a posterioanterior approach was used to perform vaginal hysterectomy in these patients. Vaginal hysterectomy was completed in all 64 cases. Vaginal salpingo-oophorectomy was performed in 3 (4.68%) cases. The mean operative time was 78. 59 -33.15 (35-190) minutes. The mean weight of specimen uteri was 161.01 -108.87 (50-550) g. No patients needed conversions or blood transfusions. No patients had bladder, ureteric, or thermal injuries. Finally, there were no other major postoperative complications. Conclusions: In the absence of fixed adhesions of the uterine corpus to previous anterior abdominal scarring, vaginal hysterectomy for benign indications associated with previous cesarean section may be accomplished safely. The posterioanterior approach during vaginal hysterectomy may avoid unintended bladder injury in the presence of dense uterovesical adhesions caused by previous cesarean sections. ( J GYNECOL SURG 29:7)
To ease intra-operative access to laterally at vaginal hysterectomy, we have developed the 'Purohit technique of vaginal hysterectomy' using a right angle forceps, electrocautery and 10 mm telescope with light source. A prospective study on consecutive 214 women with benign disease of the uterus without prolapse, including cases with relative contraindications (excluding endometriosis and uteri above 20 weeks size), demonstrated it to be easy, safe and effective. Vaginal hysterectomy was successfully completed in 213 (99.53%) cases, with one failure (0.46%) which needed laparoscopic assistance. Vaginal salpingo-oophorectomy was completed in all indicated cases. We believe that many abdominal and laparoscopic hysterectomies could be avoided by this technique. Details of the technique can be seen on the following website http://www.purohittechnique.com
Objectives To study the feasibility, safety and efficacy of the newly designed Purohit technique for vaginal hysterectomy. Design Prospective observational study. Setting Urban private hospital. Methods The study involved 214 consecutive patients without prolapse. Inclusion criteria were: all benign disease of the uterus with a uterus of up to 20 weeks’ gestational size; patients were also included who had relative contraindications to the vaginal hysterectomy route, and who needed removal of movable adnexal cyst (5–7 cm) or oöphorectomy. Patients with endometriosis were excluded. Initially, vaginal hysterectomy was attempted in all patients included in the study, by means of the Purohit vaginal hysterectomy technique. Uterine arteries were secured by means of the Purohit uterine artery technique. Outcome measures These were: intraoperative and postoperative complications, duration of operation, need for laparoscopic assistance, postoperative pain, duration of hospital stay and readmission. Results The mean (± SD) weight of the removed uteri was 191.91 ± 101.52 g (range 40–950). Vaginal hysterectomy was successfully completed in 213 consecutive patients (99.53%), and failed in only one patient (0.46%) in whom laparoscopic assistance was needed to release the upper ligaments. Morcellation was required in 13.55%. Vaginal salpingo‐oöphorectomy was completed without difficulty in all 24 attempted procedures, including two patients with twisted ovarian cyst. Intraoperative bleeding was less than 100 ml in 87.85% of patients; 0.93% required blood transfusion. The mean haemoglobin loss was 0.5 g dl−1 (0.2–4.0). No major electrical injury occurred. The mean (± SD) operating time was 60.6 ± 26.53 min (25–180). Mild postoperative pain was experienced by 98.59% of patients, and the mean hospital stay was 2.7 ± 1 days (1–10). In the second postoperative week, 2.33% of patients developed haematocele above the vault of size 20–100 ml; two patients required readmission for drainage of the haematocele. Conclusion The Purohit technique is safe, and 99.53% of women with benign disease of a uterus of up to 20 weeks’ gestational size, excluding endometriosis, underwent vaginal hysterectomy, with or without salpingo‐oöphorectomy, carried out by means of this technique.
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