Abstract
Introduction and hypothesis
In this video we present the surgical management of a 58-year-old woman presenting with a large prolapsed myomatous uterus treated with vaginal hysterectomy (VH) and pelvic floor repair (PFR) (uterosacral ligament suspension and posterior colporraphy) under local anesthesia and conscious sedation.
Methods
The patient underwent VH and PFR by using an infiltration of a local anesthetic solution of lidocaine, ropivacaine and adrenaline in combination with intravenous (iv) conscious sedation. Debulking techniques, such as intramyometrial coring, uterine bisection, myomectomy and wedge resection, were used to facilitate VH. The final weight of the removed uterus was 870 g.
Results
This video demonstrates that performing a surgically challenging VH under local anesthesia is feasible.
Conclusions
Vaginal uterine morcellation can be performed to debulk the enlarged uterus so that hysterectomy can be accomplished under local anesthesia. The use of local anesthesia may safely be offered as an alternative to patients undergoing a complex vaginal hysterectomy and reconstructive surgery.
This is a preview of subscription content, log in via an institution to check access.
References
Athanasiou S, Zacharakis D, Grigoriadis T, Papalios T, Pitsouni E, Valsamidis D, et al. Vaginal hysterectomy with anterior and posterior repair for pelvic organ prolapse under local anesthesia: results of a pilot study. Int Urogynecol J. 2020;31:2109–16. https://doi.org/10.1007/s00192-020-04326-0.
Magos A, Bournas N, Sinha R, Richardson RE, O'Connor H. Vaginal hysterectomy for the large uterus. Br J Obstet Gynaecol. 1996;103:246–51. https://doi.org/10.1111/j.1471-0528.1996.tb09713.x.
Unger JB. Vaginal hysterectomy for the woman with a moderately enlarged uterus weighing 200 to 700 grams. Am J Obstet Gynecol. 1999;180(6 Pt 1):1337–44. https://doi.org/10.1016/s0002-9378(99)70016-5.
Sheth S, Malpani A. Vaginal hysterectomy for high risk patients under local anesthesia. J Gynecol Surg. 1992;8:65.
Levene JL, Weinstein EJ, Cohen MS, Andreae DA, Chao JY, Johnson M, et al. Local anesthetics and regional anesthesia versus conventional analgesia for preventing persistent postoperative pain in adults and children: a Cochrane systematic review and meta-analysis update. J Clin Anesth. 2019;55:116–27. https://doi.org/10.1016/j.jclinane.2018.12.043.
Altman AD, Robert M, Armbrust R, et al. Guidelines for vulvar and vaginal surgery: enhanced recovery after surgery society recommendations. Am J Obstet Gynecol. 2020;223:475–85. https://doi.org/10.1016/j.ajog.2020.07.039.
Zakaria MA, Levy BS. Outpatient vaginal hysterectomy: optimizing perioperative management for same-day discharge. Obstet Gynecol. 2012;120:1355–61. https://doi.org/10.1097/aog.0b013e3182732ece.
Author information
Authors and Affiliations
Contributions
T. Grigoriadis: Conception, Manuscript editing, Supervision of manuscript.
D. Zacharakis: Writing draft, Review of literature.
K. Kypriotis: Video editing.
A. Protopapas: Correction of draft.
S. Hadzillia: Anesthesiologist of the case, Manuscript editing.
S. Athanasiou: Primary surgeon, Supervision of manuscript.
Corresponding author
Ethics declarations
Conflicts of interest
None.
Additional information
Consent
Written informed consent was obtained from the patient for publication of this video article and any accompanying images.
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
(MP4 93941 kb)
Rights and permissions
About this article
Cite this article
Grigoriadis, T., Zacharakis, D., Kypriotis, K. et al. Extending the limits of vaginal hysterectomy under local anesthesia and conscious sedation. Int Urogynecol J 32, 2287–2289 (2021). https://doi.org/10.1007/s00192-021-04721-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00192-021-04721-1