Adnexectomy During Vaginal Hysterectomy for Benign Indications Using Bipolar Hemostasis of Lateral Pedicles and Transvaginal Adnexa Mobilization

Abstract

Background: Using coagulation techniques to achieve hemostasis of lateral pedicles, or a fiberoptic light source to improve visibility in a narrow operating field, or transvaginal mobilization of adhered adnexa, may facilitate more salpingo-oophorectomies after vaginal hysterectomies for benign indications. Objectives: The aim of this research was to study the feasibility of adnexectomy during vaginal hysterectomy for benign indications, using bipolar coagulation to achieve hemostasis of the lateral pedicles and using transvaginal mobilization of adnexa. Materials and Methods: A prospective observational study was conducted from May 2010 through April 2014. Consecutive candidates for vaginal hysterectomy for benign nonprolapsed indications with adnexectomy (unilateral or bilateral) were included. The outcome of interest was success of adnexectomy during vaginal hysterectomy. Results: Adnexectomy during vaginal hysterectomy was completed successfully in 220 (97.34%) of 226 indicated cases. Unilateral adnexectomy was performed in 148 (65.48%), and bilateral adnexectomy was performed in 78 (34.51%) cases. Adnexectomy during vaginal hysterectomy failed in 6 (2.65%) cases. These patients had adhered ovaries above the pelvis, could not be mobilized vaginally, and, finally, needed laparoscopic completion of adnexectomy. Conclusions: Most adnexectomies during vaginal hysterectomy for benign indications can be completed, using bipolar hemostasis and transvaginal mobilization of adhered adnexa in the pelvis. Some failed adnexectomies during vaginal hysterectomies might need laparoscopic completions to avoid laparotomies. (J GYNECOL SURG 31:86

Feasibility of bilateral salpingo-oophorectomy during vaginal hystertectomy for benign uterine diseases

“…Purohit R et al, in his study concluded that most adnexectomies during vaginal hysterectomy for benign indications can be completed, using bipolar hemostasis and transvaginal mobilization of adhered adnexa in the pelvis. 9 To gain the access and to secure the ovarian pedicle different techniques can be employed. Conventional clamping, cutting and ligating using adnexal clamp itself is enough in most situations and minimize the pedicle slippage.…”

Completion of vaginal hysterectomy by electro surgery using anteroposterior approach in benign cases faced with obliterated posterior cul-de-sac

“…After vaginal hysterectomy, adhered adnexa were mobilized from the lateral pelvic wall using transvaginal mobilization of adhered adnexa from the lateral pelvic wall using tactile feel. 9 …”

“…Adhesiolysis and adnexectomy were done vaginally under vision in indicated cases. 9 Chocolate cystectomy if any, was done to preserve ovary in indicated cases. 9 …”

“…Deaver retractors and pelvic illuminator with fiber optic light source were used occasionally to improve exposure and visibility of the deeper field of operation procedure. 8 , 9 …”

“…Experiences over the years since the description of Purohit technique of vaginal hysterectomy (PTVH) in 2003 using electrosurgery, and other procedures in this hospital, 7 – 9 streamlined and developed a straight forward below described surgical approach to deal with obliterated posterior cul-de-sac to accomplish vaginal hysterectomy.…”