NDVH (Non Descent Vaginal Hysterectomy) without Any Suture Staples or Clips Using Erbe Open Programmed Vessel Seal with Minimal Blood Loss: An Alternative Consumer Friendly Innovative Cost Effective Technique!!

Abstract

Objective: To evaluate the feasibility and safety of Erbe open programmed vessel seal biclamp electro-cautery appliances in non-descent vaginal hysterectomy (NDVH) even up to the size of twenty-two weeks of uterine mass with minimal blood loss without the application of sutures, clips and staples for uterine attachments.

Study method:: In a prospective study vaginal hysterectomy was reviewed by consecutive 1628 women from December'2004 to sept'2014 for different benign uterine diseases without any uterine descent excluding cancers, known endometriosis, previous lower abdominal scars, and uteri of more than 22 weeks size at Hitech medical college, Bbsr, Odisha, India & Melaka General Teaching Hospital, Malaysia. Under combined spinal epidural anaesthesia and adopting hydro dissection for bladder separation through vesicocervical fascia anteriorly and later entry into the pouch of Douglas, all lateral attachments of the uterus and even the infundibulo-pelvic ligaments were secured using Erbe open programmed vessel seal without applying any sutures, clips or staples. Vaginal vault was closed in one layer with bilateral postero- lateral fixation to uterosacral stump.

The results: Vaginal hysterectomy was successful in all cases without any pre-operative complications. Weight of the patient ranges from less than 60Kg – 396 cases (24.32%), 60-80 Kg-858cases (52.7%),80-100 Kg-286 cases(17.56%) and only 88 ( 5.4% )patients weighing more than 100Kg (100-116Kg).The size of the uterine mass varies from less than 12 week-836 cases(51.35%), 12-16 week- 528 cases(32.43%),16-20 week-242 cases(14.86%), and 22 patients (1.35%) were ranging more than 20 week size of uterus. The indications for NDVH were uterine Leomyomas in 539 patients (33.1%), Adenomyosis in 341 cases (20.94%), Mixed adenomyosis with fibroid in 352 cases (21.62%) and DUB (dysfunctional uterine bleeding) in 396 patients (24.32%).Bleeding was less than 20 milliliters in 968 cases (59.45%), 20-50 milliliters in 418 patients (39.18%) ,50-100ml in 220 cases and 22cases (1.35%) with more than 100 milliliters (100-130 milliliters), without requiring any blood transfusion. Mean operating time was less than 40 minutes in 1097 cases (67.38%), 40-60 minutes in 515 cases (31.62%) & more than 60 minutes in 16 cases(1%) . 902patients (55.4%) were discharged within 48 hours of hospital stay while 649 (39.86%) cases stayed up to 48- 60 hours and only 77 (4.72%) patients were discharged after 60 hours (60-66hours) of stay. One dose of Tramal injection or voltaren (diclofenac sodium) suppository was used as post operative analgesia No patient needed relaparotomy or readmission. Histo-pathology revealed benignity in all cases. More than ninety percent (1608) cases resume work within three week with excellent customer satisfaction.

Conclusion: Non-descent Vaginal hysterectomy using Erbe open programmed vessel seal electro-cautery method is feasible, safe and an effective alternative innovative armamentarium with excellent consumer satisfaction even for large uteri up to 22weeks. However large series with meta-analysis need to be addressed.