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Section-06 Failed Trial Vaginal Hysterectomy/Trial Vaginal Route

BOOK TITLE: Advanced Vaginal Surgery

Author
1. Sheth Shirish S
2. Finkelstein Seth
ISBN
9789352700172
DOI
10.5005/jp/books/14124_8
Edition
1/e
Publishing Year
2018
Pages
16
Author Affiliations
1. Breach Candy Hospital, Sir Hurkisondas Nurrotamdas Hospital and Sheth Nursing Home, 2/2, Navjivan Society, Lamington Road, Mumbai, India, e-mail:silsal@bom2.vsnl.net.in, Breach Candy Hospital and Sir Hurkisondas Nurrotamdas Hospital, Mumbai, silsal@bom2.vsnl.net.in, Sir Hurkisondas Nurrotamdas and Saifee Hospitals, Mumbai, Maharashtra, India, Breach Candy Hospital and Sir Hurkisondas Nurrotamdas Hospital, Mumbai, Maharashtra, India, Breach Candy Hospital, Sir Hurkisondas Hospital and Saifee Hospital, Mumbai, Maharashtra, India, Mumbai, King Edward Memorial Hospital and Seth GS Medical College, Mumbai, Maharashtra, India (1964–1994); International Federation of Gynecology and Obstetrics (FIGO) from 2000–2003; Breach Candy and Saifee Hospitals, Mumbai, Maharashtra, India, Breach Candy, and Saifee Hospitals, Mumbai, Maharashtra, India; International Federation of Gynecology and Obstetrics (FIGO), 2000-2003
2. Lenox Hill Hospital, Manhattan, Kingsbrook Jewish Medical Center, Brooklyn, New York, USA
Chapter keywords
Vaginal hysterectomy, VH, pelvic inflammatory disease, PID, abdominal wall, ovarian endometriosis, posterior vaginal wall, parasitic myoma

Abstract

This chapter focuses on failed trial vaginal hysterectomy or trial vaginal route. This section comprises of 12 sections that are described as undiagnosed uteroabdominal band, uterocervical adhesions with abdominal wall, diminished “uterus-free” space (altered uterocervical angle), ovarian endometriosis with positive “dimple sign”, large-sized uterus, ovarian malignancy, uterine bulk impedes descent, extensive adhesions from PID (pelvic inflammatory disease) limits descent for VH, unanticipated uterine adhesions to abdominal wall-1, unanticipated uterine adhesions to abdominal wall-2, unanticipated uterine adhesions to abdominal wall-3, and parasitic myoma and inaccessible adnexa leads to laparoscopic completion of VH. Under anesthesia, the cervix was barely seen and vulsellum was applied with difficulty. Posterior vaginal wall was pulled up and stretched. When traction was applied to the cervix, it caused dimpling in the lower abdominal wall, signaling that the uterus is likely to be adherent to the abdominal wall. Anteriorly for bladder separation, getting uterocervical-broad ligament space, there was no plane of cleavage.

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