2nd edition
Editors Neerja Goel MD MAMS FICOG FIMSA FFGSI
Professor
Shalini Rajaram MD MAMS
Professor
Rachna Agarwal MD
Assistant Professor
Sumita Mehta DGO DNB MICOG
Specialist Department of Obstetrics and Gynecology University College of Medical Sciences and Guru Teg Bahadur Hospital
Delhi, India
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
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Step by Step® Non-Descent Vaginal Hysterectomy
© 2010, Jaypee Brothers Medical Publishers (P) Ltd.
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editors and the publisher.
First Edition : 2005
Second Edition : 2010
9788184488531
Typeset at JPBMP typesetting unit
Printed at ???
5Contributors
- Neerja Goel md mams ficog fimsa ffgsi
- Professor
- Department of Obstetrics and Gynecology
- University College of Medical Sciences and Guru Teg Bahadur Hospital
- Delhi, India
- Shalini Rajaram md mams
- Professor
- Department of Obstetrics and Gynecology
- University College of Medical Sciences and Guru Teg Bahadur Hospital
- Delhi, India
- Rachna Agarwal md
- Assistant Professor
- Department of Obstetrics and Gynecology
- University College of Medical Sciences and Guru Teg Bahadur Hospital
- Delhi, India
- Sumita Mehta dgo dnb micog
- Specialist
- Department of Obstetrics and Gynecology
- University College of Medical Sciences and Guru Teg Bahadur Hospital
- Delhi, India
- Surveen Ghumman md
- Specialist
- Department of Obstetrics and Gynecology
- VMMC and Safdarjung Hospital
- Delhi, India
- Namita Grover md
- Specialist
- Department of Obstetrics and Gynecology
- ESI Hospital, Model Town
- Industrial Area, Phase 2
- Chandigarh, India
- Ashok Kumar Saxena md fams
- Professor
- Department of Anesthesiology
- University College of Medical Sciences and Guru Teg Bahadur Hospital
- Delhi, India
The fact that a book on “Vaginal Hysterectomy” is getting added to the plethora of books is testimony to its need for reader and the scientific community. Hysterectomy is one of the commonest operations in women and a gynecologist is now frequently recognized in terms of his or her level of expertise in a particular mode of hysterectomy. Literature on the subject is a need of the day, in fact, the need of the era, to clear clouded minds bombarded with the sophistication through Laparoscopically Assisted Vaginal Hysterectomy (LAVH) or Total Laparoscopic Hysterectomy (TLH) often performed by inexperienced gynecologist.
All studies indicate that hysterectomy should always be performed by the least invasive and most economical route. The vaginal route should be a gynecologist's first choice, if and when it is not contraindicated.
Laparoscopic surgery is a wonderful too and great addition to our armamentarium to help us to perform hysterectomy vaginally by undoing the obstacles preventing vaginal hysterectomy. Gynecologists and vaginal hysterectomists in particular, need to expand their horizons by progressively mastering the art of vaginal surgery through hysterectomies without laparoscopic assistance. No descent uteri form 85 to 90 percent indications for hysterectomy and more than 80 to 90 percent of these hysterectomies can be carried out vaginally.8
“Step by Step Presentation of Vaginal Hysterectomy” for non-descent uterus will provide every surgeon the required guidance and incentive to carry out this ideal method of hysterectomy. Full credit to Dr Neerja Goel, Dr Shalini Rajaram and Dr Surveen Ghumman to have penned their thoughts and feelings on the subject into a book.
This book should be a bacon to all in the field of gynecology to advance the wonderful art of hysterectomy via the vaginal route.
Shirish S Sheth
MD, FRCOG, FACS, FICS, FCPS, FICOG, FAMS, FSOGC
Consultant Gynecologist
Breach Candy Hospital Sir Hurkiscndas Hospital
9Preface to the Second Edition
The first edition of NDVH was released in 2005 which was well appreciated by practicing gynecologists and sold numerous copies. There was a request from the readers to update the present format and include newer techniques and advances. Thus, this book brings you a few new procedures which include a suture-less technique using a vessel sealing system, the BiClamp; this makes surgery effortless and almost bloodless. Another technique which is in vogue is “aqua-dissection” which produces both tamponade and allows easy dissection, is also described both in the video and in a text which is amply illustrated.
Vaginal hysterectomy is not complete without mastering the technique of oophorectomy. The hesitancy on the part of the gynecologist to attempt this procedure should be overcome and the correct technique can be learnt after assessing operability which is described in the chapter.
Volume reducing techniques improve accessibility to fundal/broad ligament structures. Various methods such as enucleation, slicing, wedge resection, coring and morcellation are described.
We hope more and more gynecologists learn NDVH as an alternative to laparoscopic hysterectomy which is expensive and has a long learning curve.
Neerja Goel
Shalini Rajaram
Rachna Agarwal
Sumita Mehta
10Acknowledgments
We offer our sincere gratitude to Dir Prof and HOD Dr Neelam B Vaid for allowing and encouraging us to pursue our academic venture.
We must thank Dr KC Singh a colleague and a friend who inculcated the art of fine surgery in all of us. He is presently working as consultant in Melbourne, Australia.
Dr Ashok Kumar Saxena has had a very long association with us and his cooperation has come to his pen. He has highlighted the finer aspects of operative anesthesia in patients undergoing gynecologic intervention. We also acknowledge the incessant co-operation and clinical assistance of all the staff of our operation theatre.
We thank all the residents of our unit, especially Dr Neha Kumar, for showing tremendous patience and co-operation in this endeavor.
In the end we show our gratitude to our family members who gave us their full co-operation and supported us throughout.