A Tally Of TLH Vs. NDVH -The Current Scenario In Benign Pathologies

 Dr,B.roychoudhury,Dr.P.Sanyal,Dr.S.N.Bandopadhyay

Clinical Tutor IPGMER KOLKATA,Consultamnt Woodlands Multispeciality hospital,Associate Professor IPGMER KOLKATA

INTRODUCTION

Hysterectomy is the second most common surgery performed by gynaecologist

Traditionally,the uterus has been removed by abdominal route which gives the opportunity to inspect the ovaries and vaginal route was reserved for POP.

However now emphasis on MIS has led to resurgence of interest and importance of vaginal hysterectomy for non prolapse indication i.e.NDVH as the scarless hysterectomy.In this era of robotic and laparoscopic surgery,considering the advantage of MIS along with precision,we did a study on NDVH which is an art of gynaecological surgeon giving us an edge over general surgeons.NDVH also gives us option of minimal invasion with better access to ligament of uterus for surgery with less blood loss and minimal analgesic requirement post surgery and under a relatively safe spinal anaesthesia rather than general anaesthesia with its complications

RESULTS:

The results were analyzed by SPSS Software version 29 using various statistical methods .

• Demographic data analysis showed both the groups have similar age distribution
• Multiparity was more common in NDVH group
• AUB was the most common indicator in both groups
• Uterus of size 16 weeks could be operated by vaginal route
• Both groups were compared in co-morbidities like hypertension and diabetes
• NDVH was done for few women with morbid obesity where risk of general anaesthesia was very high
• Comparison of the parameters show that operating time,blood loss,Hb change,hospital stay,post op pain and blood transfusion were significant
• No cases in NDVH group were converted to laparotomy while 2 cases in TLH group were converted to laparotomy
• Additional advantage in NDVH was repair of cystocele and rectoele
• Adhesiolysis was the other common advantage which could be done in the TLH group
• There were no intraoperative complications in NDVH group while 1 cases of bladder injury and 1 case of ureteric injury were seen in TLH group which were converted to laparotomy to deal with complications
• In both groups all patients were ambulated by 6 hrs post surgery
• However hospital stay was found to be significantly less in NDVH group

CONCLUSION

Vaginal hysterectomy for non descent for large uterus is safe and feasible provided one is familiar with the technique.Our study shows NDVH can be offered to  women with comorbidities like asthma and high BMI, without increase risk of anaesthetic complications.Operative time and intraoperative blood loss are also less compared to TLH.With experience NDVH can be done uterine size > 12 weeks.Thus this scarless approach appeared to be preferred method of hysterectomy.

FUNDING-Nil

CONFLICT OF INTEREST-None

ETHICAL APPROVAL-Taken

INFORMED CONSENT-Obtained from all patients

LIMITATION

1. Uterine size
2. Previous pelvic surgery
3. Endometriosis
4. Nulliparity
5. Uterine size
6. > 16 weeks
7. Surgeon’s bias
8. REFERENCES:
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