I had not thought there would be any difficulty in performing a vaginal hysterectomy when there was no portio vaginalis of the cervix to catch and pull on. It came as a surprise when my people admitted a woman with cervical intraepithelial neoplasia diagnosed by cervical biopsy performed twice by others outside our hospital, and wanted to perform a total hysterectomy on her by the abdominal route.
“See, her cervix is flush with the vagina. We had a great difficulty catching the cervix for performing end cervical curettage” the Associate Professor said. She was showing me the cervix by performing a speculum examination. The external os and the outline of the portio vaginalis were seen, but there was no elevation of the cervix. I performed a mimanual pelvic examination and found that the uterus was not enlarged or fixed.
“But why do you want to operate abdominally? It can be done vaginally” I said.
“Sir, there is no cervix to hold. What will we hold and pull on during vaginal hysterectomy?” she asked me.
“We elevate a vaginal cuff all round the cervix, and then catch the supranational cervix” I said. “Then the hysterectomy can be done as usual. It is unnecessary to perform the operation abdominally only because there is no cervix to hold.” I knew it. I had done that before, without thinking about it.
No one said anything.
“I will do it. Once I get the supranational cervix held with Allis’ forceps or a suture for traction, you can complete the hysterectomy” I said.
“We will do it” she said with uncertainty. I was afraid of that uncertainty and decided to do it myself. Two days later the patient was scheduled for the operation. I reached the OT in time and told them I would do it. There was indeed no way of holding the cervix. The Allis forceps slipped off its surface. So I held the vagina around the cervix, incised it with the tip of a scalpel blade, and elevated a cuff of the vagina all round. The space was very limited, but it was possible. Then I applied a tenaculum across the front and the back of the supranational cervix and made traction. It held. The remaining hysterectomy by the vaginal route was uneventful.
“It would have been too much performing it abdominally only for that indication” the Associate Professor said. She was repeating to me what I had said to them all two days ago.
“Sir, I read some books and searched the net for difficult vaginal hysterectomy” said my senior Assistant Professor. “I did not find this technique anywhere.”
“Now you know how to do it” I said. I am writing it here, so that others who search the net for it will find it in future.
