Docs develop womb-removal method that lowers complications

NEW DELHI : Doctors from the All India Institute of Medical Sciences (AIIMS) have developed a technique for performing hysterectomies (a procedure to remove the uterus) that prevents damage to the pelvic nerves and injuries to the ureter and bladder, reduces blood loss, and preserves proper functioning of the bladder and bowels. The new procedure takes between 30 minutes to an hour more than the standard technique, but improves the quality of life immensely, according to medical practitioners.

Hysterectomy is the second most common gynaecological procedure after caesarean sections. It is also done for uterine, ovarian, and endometrial cancers, one of the most common cancers among women.

“The major problem during a hysterectomy is excessive bleeding. The pelvic region is very vascular and there is a lot of blood loss even when the procedure is performed meticulously and with the help of new vessel-sealing devices. The excessive blood loss also means that surgeons have to act fast, which results in nerve, vessel, ureter [the tube that carries urine from the kidney to the bladder], and bladder damage,” said Dr MD Ray, professor of oncology at AIIMS.

A doctor from the department of cancer at AIIMS has defined a ‘red-alert zone’, which includes parts of the ureter, vessels and nerves of the cervix and bladder, pelvic nerves, and the base of the bladder. The new procedure preserved proper bladder, bowel and sexual functions in the 105 patients who underwent surgeries under the modified technique.

“After a hysterectomy, women report issues with bladder and bowel control. They report feeling the urge to urinate and defecate, but are unable to. There is sexual dysfunction because of the nerve damage in the region. These are the common concerns we address during the follow-ups. However, the women who underwent the new surgery did not report these issues,” Ray said.

The new technique also resulted in less bleeding — a loss of 50 to 100ml of blood in comparison to 500 to 800ml during the standard procedure.

The new technique involves visualising the red-alert zone better with the help of a 2.5x magnifying glass, ligating or tying up each vessel individually, and using instruments such as bipolar scissors and Cavitron Ultrasonic Surgical Aspirator (CUSA) instead of a cautery (an instrument used to burn a part of the body to remove it or close it off.)

“Any procedure that reduces blood loss and chances of injury will reduce the recovery time and improve the quality of life. Complications such as injury to the bowels or vessels do happen. Currently, robotic surgery helps improve the visualisation and reduce risks. It is the second most common procedure in women, so the impact of any improvement will be great,” said Dr Rupali Dewan, head of the department of obstetrics and gynaecology, Vardhaman Mahavir Medical College and Safdarjung Hospital.

This procedure requires a lot of practice and deep knowledge of the anatomy of the region, but it should become the gold standard for hysterectomies as it improves the quality of life immensely.

DR MD RAY, professor of oncology at AIIMS