Themos Grigoriadis1, Dimitrios Zacharakis2,3, Konstantinos Kypriotis1, Athanasios Protopapas1, Sofia Hadzillia4, Stavros Athanasiou1. 1. Urogynecology Unit, 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Faculty of Medicine, Athens, Greece. 2. Urogynecology Unit, 1st Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Faculty of Medicine, Athens, Greece. dimzac@hotmail.com. 3. First Department of Obstetrics and Gynecology, Alexandra General Hospital, University of Athens, 80 Vas. Sofias Aven, 11528, Athens, Greece. dimzac@hotmail.com. 4. Department of Anaesthesiology, "Alexandra" Hospital, Athens, Greece.
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.
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.
Authors: Alon D Altman; Magali Robert; Robert Armbrust; William J Fawcett; Mikio Nihira; Chris N Jones; Karl Tamussino; Jalid Sehouli; Sean C Dowdy; Gregg Nelson Journal: Am J Obstet Gynecol Date: 2020-07-24 Impact factor: 8.661
Authors: Jacob L Levene; Erica J Weinstein; Marc S Cohen; Doerthe A Andreae; Jerry Y Chao; Matthew Johnson; Charles B Hall; Michael H Andreae Journal: J Clin Anesth Date: 2019-01-11 Impact factor: 9.452