DR SACHIN V. NAIKNAWARE. GYNAEC LAPAROSCOPIC SURGEON.
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HYSTERECTOMY IS SURGICAL REMOVAL OF UTERUS. it is one of the commonest major gynaecological surgical procedure performed.the choice of hysterectomy as a therapeutic procedure will depend on patients age,her wish for pregnancy,and desire for preserving the uterus.although there is general agreement as to the indications of hysterectomy,the incidence of different pathologic conditions leading to surgery varies considerably.
with addition various minimally invasive surgical techniques including laparoscopic hysterectomy and robotic surgery addition to conventional abdominal and vaginal route for surgery,still majority of hysterectomies are performed abdominally.
INDICATIONS FOR HYSTERECTOMY:-
- FIBRIOD UTERUS
- ADENOMYOSIS
- SEVERE ENDOMETRIOSIS.
- ABNORMAL VAGINAL BLEEDING.
- SEVERE PID.
- CERVICAL INTRAEPITHELIAL NEOPLASIA.
- INVASIVE CERVIX CANCER.
- OVARIAN OR ENDOMETRIAL CANCER.
- CHRONIC PELVIC PAIN UNRESPONSIVE TO OTHER TREATMENT
Abdominal hysterectomy is still most common approach used worldwide.even though vaginal route is associated with fewer complications,short hospital stay,more rapid recovery,and lower overall cost.conventionally patients with gynaecological malignancies, uterus size more than 12 wks, limited uterine prolapsed,large cervical fibroid,, cervix malignancy,large adnexal mass, severe adhesions due to previous abdominal surgeries are the candidates for abdominal hysterectomy.some of the complications associated with abdominal route are haemorrhage,bleeding , infection and trauma to adjutant organs such as bladder and bowel.
VAGINAL HYSTERECTOMY when feasible is the safest and most cost effective procedure for the removal of uterus.there are no absolute contraindications for vaginal hysterectomy,however some factors that may influence the surgeons choice of route of hysterectomy are surgeons training and experience,accessibility of uterus,extent of extrauterine disease,size and shape of uterus,, need for concurrent procedures,and patients preference. A chorine review found that vaginal route compared with all other routes of hysterectomy,vaginal hysterectomy yield better outcome,and fewer complications.various studies shows that vaginal hysterectomy should be performed whenever technically feasible to reduce complications and shorten hospital stay accelerate patients recovery.
THE LAPAROSCOPIC HYSTERECTOMY was introduced in 1989 as an alternative to abdominal hysterectomy which aims to achieve same medical effectiveness for quicker recovery.since its introduction there is tremendous change in terms of laparoscopic instrumentation and techniques.though laparoscopic hysterectomy is technically demanding, it also has many advantages.
laparoscopic hysterectomy can be either total laparoscopic hysterectomy where all the steps including ligation of uterine arteries is done laparoscopically and in laparoscopic assisted vaginal hysterectomy , uterine arteries are ligated vaginally. laparoscopic single site surgery most commonly seen as single port surgery has gained momentum as a feasible techniques.
conventional laparoscopy has some limitations imposed by incision size,and normal mechanism of human hand,to overcome this surgical robots are developed.this robotic system provides a steady 3-D image and instrumentation with articulating tips that allow for 7 degrees of movement,surpassing wrist mobility which allows its use in patients with complex pathology for whom conventional laparoscopy often prove difficult.
with the aim of decreasing morbidity,cost of surgery,and hospital stay,according to patients conditions and associated pathology route of surgery is too individualised. vaginal hysterectomy and laparoscopic hysterectomy have shown definite advantages over abdominal hysterectomy but abdominal approach should not be disregarded as it can still prove to very useful in difficult situation.