Non-decent Vaginal Hysterectomy in Rural Setup of MP: A Poor Acceptance

Abstract

Objective NDVH is a minimally invasive, safe, effective, and economical surgery. Still AH is preferred for benign gynaecological indications. Our study aims to promote NDVH in all technically possible cases by adequate counselling of the patient. Methods This prospective observational study enrolled 100 women seeking hysterectomy for benign gynaecological conditions (excluding prolapse) in a teaching hospital.Women were counselled on the basis of 'PREPARED' questionnaire to assess their awareness about NDVH and were offered NDVH as the proposed surgery and result is analysed. Results We observed that there was a little awareness about NDVH and its outcome among the subjects. Ten out of 100 patients refused to perform NDVH after counselling and underwent TAH. Rest of the 90 patients opted for NDVH. Forty out of 90 patients were aware about NDVH, but they were sceptical about the outcome, and 50 were totally unaware. After applying 'PREPARED' questionnaire and counselling, we could motivate them to accept NDVH. It was successful in all cases except one where laparotomy was done for ovarian artery retraction. With no significant post-operative complications, early return to routine activity and low cost of surgery, all patients were satisfied with surgical outcome and improved quality of life. 123 the procedure. Most of the abdominal hysterectomy can be converted successfully to NDVH in technically feasible cases by experienced hands so adequate training to gynaecology residents is the need of the time. NDVH is economical to the patient as well as for the healthcare system.

Keyhole to no hole hysterectomy - A retrospective analysis of NDVH and TLH in a teaching hospital

“…Thus there are many reasons for vaginal hysterectomy to be considered as the gold standard in minimally invasive approaches of hysterectomy as it was found to be cost effective and cosmetically appealing among all routes as observed by Krishna avatar et al 18 NDVH a natural, original orifice surgery with these distinct and undisputed evidences, still appears to be poorly accepted both among surgeons and patients so physician have an obligation to make patient aware of the advantages and disadvantages of available surgeries so together they can select the best option. 19 Dr. Thomas Julian in 2008 has written a wonderful and prescient commentary about this paradox, entitled 'Vaginal Hysterectomy :An apparent Execption to Evidence Based Decision Making. He discussed some of the reason for its decline, including clever marketing, the myth that" newer "equals "better" and mostly a lacking of training for current residents and post graduates who more and more feel uncomfortable performing what he consider to be the easiest method of hysterectomy.…”