Endoscopic assisted vaginal oophorectomy: a minimal access surgical techniques at vaginal hysterectomy

ABSTRACT

Although the advantages of vaginal hysterectomy are well documented, most hysterectomies are still performed abdominally. However, one of the limitations of vaginal hysterectomy is the accessibility of the ovaries particularly in cases with no uterine prolapse. Therefore, it is needed to master techniques of ovarian removal at vaginal hysterectomy. This study reports 100% success rate in removing ovaries in 48 cases at time of vaginal hysterectomy using three different methods of endoscopic assisted vaginal oophorectomy. A 30 degree 10 mm panoramic view diagnostic telescope was used. in absence of pelvic adhesions [n = 40], two different methods of vaginal oophorectomy were used. The Seitsinger tripolar cutting foreceps [Cabot Merdical, Langhorne, USA], and the endoloop using number one polyglactin polymer [vicryl, ethicon, Edinburgh, UK]. In presence of pelvic adhesions, however, [n = 8] adhesiolysis was done under combined minilaparoscopic and culdoscopic assistance using bipolar coagulator and scissors, followed by ovarian extraction through the vaginal canula. The mean operation time for oophorectoiny was 28 minutes [range 18-45], including adhesiolysis, when needed [n = 8], with no injury to ureter, bladder or bowel, and without increased blood loss. In conclusion, the result, of this study confirm that vaginal hysterectomy with vaginal endoscopic assisted oophorectomy is safe and easy to learn and may be an alternative to laparoscopic assisted vaginal hysterectomy even in the presence of pelvic adhesion or to laporoscopic total hysterectomy even in absence of uterine prolapse