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Non-Descent Vaginal Hysterectomy
Shalini Rajaram, Neerja Goel, Rachna Agarwal, Sumita Mehta
CHAPTER 1:
Introduction
CHAPTER 2:
Indications and Contraindications for Non-Descent Vaginal Hysterectomy (NDVH)
INTRODUCTION
Dysfunctional Uterine Bleeding
Adenomyosis
Fibroids and Enlarged Uterus
Learning Curve
CHAPTER 3:
Preoperative and Peroperative Assessment
CHAPTER 4:
Anesthetic Considerations for Non-Descent Vaginal Hysterectomy
INTRODUCTION
Rationale for using Regional Anesthesia
Neuraxial Blocks for NDVH Operation
EQUIPMENT REQUIRED
Steps for Combined Spinal-epidural Block (Figs 4.3 to 4.11)
Drugs Used
Advantages of CSE Technique
Complications of CSE Technique
Immediate
Delayed: Very rare, but Need to be Mentioned
Contraindications
CONCLUSION
CHAPTER 5:
Basic Technique for Normal Size Uterus
INTRODUCTION
INSTRUMENTS
SPECIAL INSTRUMENTS
Suture Material
Operative Technique
Position of Patient
Step 1
Step 2
Step 3
Step 4
Step 5
Step 6
Step 7
Step 8
Step 9
Step 10
CHAPTER 6:
Clampless Procedure for NDVH
INTRODUCTION
Steps 1-6
Step 7
Step 8
Step 9
Step 10
Step 11 and 12
CHAPTER 7:
Aqua Dissection in NDVH
INTRODUCTION
What is Aqua Dissection?
Technique
Indications
Material (Fig. 7.1)
Step by Step Technique
CHAPTER 8:
Vessel Sealing System in NDVH
LIGASURE VESSEL SEALING SYSTEM (BiClamp)
Instrument
Mechanism of Action
Operative Technique
Advantages of using LigaSure
Complications
CHAPTER 9:
Volume Reductive Vaginal Hysterectomy
INTRODUCTION
Volume Reductive Surgeries
Bisection7
Myomectomy/Enucleation7
Morcellation7
Intramyometrial Coring7
Preoperative Evaluation of Large Uteri before Vaginal Hysterectomy by Ultrasound
Steps of Volume Reduction Procedure in NDVH in representative cases
A Case of Multiple Intramural Fibroid
Steps of Morcellation in Case Adenomyosis by Slicing Method9
Pryor Technique of Uterine Morcellation2 (Figs 9.14A to D)
Steps of Intramyometrial Coring3 (Figs 9.15 to 9.17)
CONCLUSION
CHAPTER 10:
Vaginal Oophorectomy
INTRODUCTION
PREREQUISITES FOR OOPHORECTOMY5
ASSESSING FEASIBILITY FOR OOPHORECTOMY6
CONTRAINDICATIONS FOR OOPHORECTOMY5
OPERATIVE TECHNIQUE5
Step by Step
COMPLICATIONS OF SURGERY7
NEWER METHODS
CONCLUSION
CHAPTER 11:
Common Problems and their Management
INTRODUCTION
NULLIPARITY
OBESITY OR INCREASED BMI
PREVIOUS CESAREAN SECTION
Opening of Posterior Pouch
Anterior Pouch
CHAPTER 12:
Reasons for Failure
INABILITY TO OPEN ANTERIOR POUCH
Anterior Myoma
Solution
Adherent Bladder
Solution
Points to Remember
DIFFICULTY IN OPENING THE POUCH OF DOUGLAS
RESTRICTED MOBILITY OF UTERUS
ERROR IN JUDGMENT OF SIZE OF UTERUS
FIBROIDS
INACCESSIBLE FIBROIDS
Inaccessible Anterior Wall Fibroids are often Reason for Failure
Solution
Points to Remember
Laterally Placed Fibroid
Soft Degenerated Fibroid
Solution
UNIFORMLY ENLARGED UTERUS—ADENOMYOSIS
ADNEXAL PATHOLOGY
SLIPPING OF VASCULAR PEDICLE WITH RETRACTION OF BLEEDER
INEXPERIENCED SURGEON AND UNENTHUSIASTIC ASSISTANTS
Overconfident Surgeon
CHAPTER 13:
Complications
INTRODUCTION
‘FAILED’ VAGINAL HYSTERECTOMY OR CONVERSION TO LAPAROTOMY
INJURY TO BLADDER, RECTUM AND URETER
HEMORRHAGE, VAGINAL BLEEDING AND HEMATOMA
MORTALITY
CHAPTER 14:
Analysis of Data
RESULTS
CONCLUSION
DATA ON VOLUME REDUCTIVE TECHNIQUES
Results
CHAPTER 15:
The Future and Resident Training for NDVH
INTRODUCTION
CHAPTER 16:
Sterilization Methods for Surgical Equipment
AUTOCLAVING (STEAM STERILIZATION)
Temperature
Time
Characteristics of the Steam
Steam quality
Air in the Autoclave Chamber
Personnel Errors
Steam Sterilization Monitoring
Advantages and Disadvantages of Autoclaving
CHEMICAL DISINFECTION AND STERILIZATION
Alcohols
Glutaraldehyde
Chlorhexidine
CHEMICAL GAS STERILIZATION
INDEX
TOC
Index
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