Clampless vaginal hysterectomy in women with nonprolapse: evaluation of a new technique

Document Type : Original Article

Author

Obstetrics and Gynecology Department- Mansoura University-Egypt

Abstract

Background: Vaginal hysterectomy is the least invasive method of removal of uterus.
Most of hysterectomies can be performed vaginally. The lower rate of vaginal hysterectomy is not only due to the relative contraindications to the vaginal route of hysterectomy
but also due to the technical barriers in the mind of most surgeons to deal with inadequate
accessibility, poor visibility and effective hemostasis even after considerable experiences.
I aim to evaluate a clampless technique for vaginal hysterectomy in comparison to the
standard technique in patients without genital prolapsed.
Methods:$IWHUHWKLFDODSSURYDOZRPHQDGPLWWHGWR*\QHFRORJ\'HSDUWPHQW0DQVXUD8QLYHUVLW\+RVSLWDOIRUK\VWHUHFWRP\IRUEHQLJQOHVLRQVGXULQJWKHSHULRGIURP0D\
WR1RYHPEHUKDGEHHQGLYLGHGWRJURXSVJURXS $ FRPSULVHGZRPHQ
in whom a clampless technique used, and group (B) comprised 25 women in whom the
standard technique using clamps has been used.
Results: The study comprised 46 women assigned for vaginal hysterectomy for benign
indication mostly abnormal uterine bleeding. They were divided randomly into 2 groups;
group- A (21 women), for whom a clampless vaginal hysterectomy was performed, while
the other group- B (25 women) used as a control (standard) group for whom the standard
technique for vaginal hysterectomy was performed.
7KHUHZHUHQRVWDWLVWLFDOO\VLJQL¿FDQWGLIIHUHQFHEHWZHHQERWKJURXSVUHJDUGLQJWKHGHmographic data (p- value > 0. 05) in all. The mean age for both groups was 51.7 and 52.0
years respectively. The mean gravidity was 4.14 and 4.92 respectively. Mean parity for
group A was 3.47 and that for group B was 3.16. T he BMI was 29.28 kg/m2 for group A
while 29.16 kg/m2 for group B.
1RVWDWLVWLFDOO\VLJQL¿FDQWGLIIHUHQFHVZHUHIRXQGEHWZHHQERWKJURXSVDVUHJDUGVWKH
preoperative uterine volumes 232.8 mL vs. 213.0 mL respectively. The mean operative
time (in minutes) for vaginal hysterectomy in group A was 92.3±7.45 while it was 94.0±
ZLWKQRVLJQL¿FDQWGLIIHUHQFHEHWZHHQERWKJURXSV7KHPHDQYDOXHVRISUHDQG
SRVWRSHUDWLYHKHPRJORELQFRQFHQWUDWLRQVZHUHQRWVLJQL¿FDQWO\GLIIHUHQWLQWKHWZRVWXG\
groups (Figure 1).
Conclusion: Finally we can conclude that clampless vaginal hysterectomy is a technique
that can be practiced as alternative to traditional technique using clamps.
Keywords: clampless, vaginal, hysterectomy

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