Evaluation of outcome following paracervical infiltration with or without saline and adrenaline during vaginal hysterectomy

Background: Paracervical infiltration is used in vaginal hysterectomy to facilitate dissection. Use of paracervical infiltration however can be associated with local ischemia and infection. We did a study to find out its benefits during vaginal hysterectomy.Methods: It was a prospective case control study. Patients were divided into two groups. In the first group, no paracervical infiltration was given. In the second group paracervical infiltration was given before hysterectomy. The operating time, blood loss and postoperative infection were noted in each group.Results: The operating time was slightly higher in vaginal hysterectomy group without infiltration (p=0.025) The operating time in laparoscopic assisted vaginal hysterectomy group was not significant (p=0.0296). There was significant difference in Hemoglobin after surgery in both groups (p value 0.614 for vaginal hysterectomy and 0.173 for laparoscopic assisted vaginal hysterectomy). There was no case of infection in both groups.Conclusions: From our study, we concluded that paracervical infiltration offers no distinctive advantage during vaginal hysterectomy or laparoscopic assisted vaginal hysterectomy.

Comparison between paracervical and intracervical block before procedures on uterine cavity and cervical dilatation

Background: Procedures like dilatation and curettage and manual vacuum aspirations are one of the commonest procedures conducted in the outpatient Department of Obstetrics and Gynecology. Objective of present study was to find out whether intracervical block is as effective as paracervical block in patients undergoing cervical dilatation and procedures on uterine cavity.Methods: Patients undergoing dilatation and curettage or manual vacuum aspiration were given either paracevrical block or intracervical block. The pain during cervical dilatation and curettage or manual vacuum aspiration were assessed on a 10 cm visual analogue scale.Results: Mean visual analogue score during dilatation was comparable in both groups. Mean visual analogue score were comparable during dilatation in both groups before curettage or manual vacuum aspiration. Mean visual analogue scores during manual vacuum aspiration or curettage was also comparable with both groups. One patient had a serious side effect of convulsion during paracervical block.Conclusions: Intracervical block is preferable to paracervical block during procedures like cervical dilatation and on procedures on uterine cavity as intracervical block requires less technical precision than paracervical block

Selective cauterization of supporting ligaments at Non Descent Vaginal Hysterectomy (NDVH)

Background: The objective of the study was to study the use of electrocautery selectively for cardinal uterosacral ligament complex during NDVH.Methods: We performed a series of NDVH where electrocautery was used selectively for the uterosacral cardinal ligament complex. Rest all stumps were clamped, divided and ligated.Results: We did a series of 21 cases using this technique and found this as a very effective method of doing NDVH. There were no major complications.Conclusion: Selective use of electrocautery for uterosacral and cardinal ligament complex makes NDVH easy