Purohit technique of vaginal hysterectomy: a new approach performed in 214 patients

ABSTRACT Objectives To study the feasibility, safety and efficacy of the newly designed Purohit technique for vaginal hysterectomy. Design Prospective observational study. Setting Urban private hospital. Methods The study involved 214 consecutive patients without prolapse. Inclusion criteria were: all benign disease of the uterus with a uterus of up to 20 weeks’ gestational size; patients were also included who had relative contraindications to the vaginal hysterectomy route, and who needed removal of movable adnexal cyst (5–7 cm) or oöphorectomy. Patients with endometriosis were excluded. Initially, vaginal hysterectomy was attempted in all patients included in the study, by means of the Purohit vaginal hysterectomy technique. Uterine arteries were secured by means of the Purohit uterine artery technique. Outcome measures These were: intraoperative and postoperative complications, duration of operation, need for laparoscopic assistance, postoperative pain, duration of hospital stay and readmission. Results The mean (± SD) weight of the removed uteri was 191.91 ± 101.52 g (range 40–950). Vaginal hysterectomy was successfully completed in 213 consecutive patients (99.53%), and failed in only one patient (0.46%) in whom laparoscopic assistance was needed to release the upper ligaments. Morcellation was required in 13.55%. Vaginal salpingo‐oöphorectomy was completed without difficulty in all 24 attempted procedures, including two patients with twisted ovarian cyst. Intraoperative bleeding was less than 100 ml in 87.85% of patients; 0.93% required blood transfusion. The mean haemoglobin loss was 0.5 g dl −1 (0.2–4.0). No major electrical injury occurred. The mean (± SD) operating time was 60.6 ± 26.53 min (25–180). Mild postoperative pain was experienced by 98.59% of patients, and the mean hospital stay was 2.7 ± 1 days (1–10). In the second postoperative week, 2.33% of patients developed haematocele above the vault of size 20–100 ml; two patients required readmission for drainage of the haematocele. Conclusion The Purohit technique is safe, and 99.53% of women with benign disease of a uterus of up to 20 weeks’ gestational size, excluding endometriosis, underwent vaginal hysterectomy, with or without salpingo‐oöphorectomy, carried out by means of this technique.