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A Combined Strategy of Vaginal Hysterectomy by Electrosurgery with Post Hysterectomy Check Laparoscopy in Benign Indications Associated with Known or Suspected Concomitant Pelvic Disease: A Retrospective Study

Author(s): Ramkrishna Purohit, Jay Gopal Sharma, Devajani Meher, Mohammed Mahmoud Samy, Rupam Sarkar

Purpose: A vaginal hysterectomy (VH) may be preferred when possible. However, VH is less than the ideal in benign cases with known or suspected concomitant pelvic disease and a laparoscopic approach of the hysterectomy may be favoured. The laparoscopic hysterectomy requires more surgical skills. The aim of the study is to demonstrate a combined strategy of vaginal hysterectomy by bipolar sealer -shear with post-hysterectomy check laparoscopy (VHPHCL) over lapa-roscopic assisted vaginal hysterectomy (LAVH) in cases with known or suspected concomitant pelvic disease.

Patients and methods: In a retrospective study in a private setup, outcomes of cases who underwent VHPHC operation were compared with cases of LAVH operation using statistical analysis and tests of the recorded data from December 2019 through January 2021.

Results: Total 574 cases underwent the hysterectomy for the benign non-prolapsed uterus below 16 weeks size. 426(74.21%) of them had no known or suspected concomitant pelvic disease 134(23.34%) cases under-went VHPHCL, and 14(2.43%) cases underwent LAVH operations. Found that, the frequency of laparoscopic surgery significantly got reduced to 17.91% after vaginal hysterectomy in the combined VHPHCL strategy compared to100% in LAVH strategy. Thus, the laparoscopic operation time significantly decreased in VHPHCL strategy compared to LAVH strategy mins (12.20 ± 5.88 (5-40) mins (95% CI=11.20-13.21) vs 34.28 ± 15.06(15-60) mins (95% CI=25.58-42.98) p-value 0.0001. Similarly, the mean total VHPHCL operation time was significantly decreased compared to mean total LAVH time (88.95 ± 28.26(50-200) mins (95% CI=84.12-93.78) vs 122.64 ± 37.82(50-190) mins (95% CI=100.80-144.48) p-value 0.0001. The VHPHCL strategy was completed with low (8-10mm of Hg) intraabdominal pressure and two abdominal ports in most cases. There was no vault dehiscence or major complication in either strategy.

Conclusion: The combined VHPHCL strategy can be performed in place of LAVH in most cases with known or suspected concomitant benign pelvic diseases.

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