Purohit Technique

This technique increases lateral accessibility and visibility. This technique is safe and effective in conducting the vaginal hysterectomy, and salpingo-oophorectomy in almost all cases of benign disease with a uterus up to 18 weeks of gestation, and without prolapse, irrespective of most pre-existing conditions regarded as relative contraindications to vaginal hysterectomy.

It increases accessibility and visibility to narrow working spaces between the uterus and the pelvic sidewall. This newer technique has almost eliminated the traditional difficulties in the completion of the vaginal hysterectomy. Vaginal hysterectomy has been made easy, accessible, and visible. However, many gynecologic surgeons traditionally do not believe in the security of the uterine artery after bipolar cauterization and division. It is indeed reliable, similar to that of the laparoscopic hysterectomy.

How this technique increases lateral accessibility.

Vaginal walls are incised by monopolar current (30-35 watts). A right-angle forceps instead of the index finger is used throughout to elevate, hook, stretch, spread, and retract all the lateral attachments of the uterus and vessels from their posterior aspects. Tissues were desiccated by bipolar current (45 watts) and divided between the prongs of forceps. Uterine arteries are secured extraperitoneally by the Purohit approach to the uterine artery. In Purohit technique of the vaginal hysterectomy, the main player is a right-angle forceps. It eases the vaginal hysterectomy. An ordinary long, thin bipolar forceps is used. Liga -Sure and Harmonic or any other energy-based forceps may be used in the place of the bipolar current. We do not use thick hysterectomy clamps, needles, and sutures that are used in conventional methods. The suture is only used for vault anchoring and vault closure.

How this technique increases lateral visibility.

Utilization of a thin rigid long torch-like 10 mm telescope with the light source or a pelvic illuminator to transmit light into the deeper and darker operation field increases visibility. It further makes the operation easier. Conventional volume reduction maneuvers were used as associated procedures in cases of large uteri to create the parauterine space for bipolar forceps and scissors. Thus, our technique overcomes the problems due to narrow lateral space and poor visibility in the vaginal hysterectomy.

Frequency of need of Morcellation

Only 13.55% of cases required morcellation of the uterus to reduce volume. Because of the increased lateral accessibility and visibility, the uterus of 280 grams seldom needs morcellation. They are removed intact. Using this technique, we have removed uteri of 400 and 430 grams intact (specimen photograph) without the need for morcellation.

Salpingo-oophorectomy during the vaginal hysterectomy

We have conducted salpingo-oophorectomy during the vaginal hysterectomy in all indicated cases including a case of the benign unilocular simple ovarian cyst of 20 weeks size. There, the cyst was aspirated before it was excised. Hydrosalpinx, benign adnexal cysts, adnexal mass, could be safely removed by this technique.

Adhesiolysis during the vaginal hysterectomy

Adhesions could be easily dissected by right-angle forceps, coagulated by bipolar forceps close to the uterine wall, and divided by scissors to release the uterus and ovaries. History of previous pelvic operation has not been a contraindication to our technique.

Advantages

This newer technique promises advantages of a high success rate, almost no need of conversion, low frequency of the requirement of volume reduction maneuvers, less intraoperative and postoperative bleeding, mild postoperative pain, early discharge from the hospital, and early resumption of routine work. Thus, it will reduce costs and complications. The surgeon who is in favor of the vaginal hysterectomy will inflate his limit. The surgeon who is not in favor of the vaginal hysterectomy will think to go for the technical vaginal hysterectomy to provide maximum comfort (no scar no pain) of the removal of the uterus to a loyal customer. Women will not be afraid of undergoing removal of the uterus through this technique. A number of fancy laparoscopic hysterectomies will be brought down. Learning is easy.

To watch the video, kindly search You Tube Purohit technique channel link. Kindly feel free to contact Dr. Purohit for any doubt regarding the technique.

References

1

• Ram Krishna Purohit: Purohit technique of vaginal hysterectomy:
• a new approach BJOG (British Journal of Obstetric and Gynaecology):
• an International Journal of Obstetrics and Gynaecology, 2003 Dec, Vol. 110 (12) pp. 1115-1119
• View this document:To download right click and select save link as

2

• Ram K. Purohit: Purohit technique of vaginal hysterectomy:
• A new approach performed in 214 patients.
• Gynaecological endoscopy 2002 Dec; 11(6); 423-430
• View this document:To download right click and select save link as

3

• R. K. Purohit, A. K. Pattnaik:
• Vaginal Hysterectomy by Electrosurgery (An Extraperitoneal Approach),
• J Obstet Gynecol India Vol.51, No. 5: September/October 2001 Pg 162-164
• View this document:To download right click and select save link as

4

• Purohit Ram Krishna, Tripathy Prakash Narayan, Pattnaik Abhaya Kumar:
• Vaginal Hysterectomy Using Electrocautery and Purohit Approach To Uterine Artery,
• J Obstet Gynecol India Vol.53, No. 5: September / October 2003 Pg 475-478
• View this document:To download right click and select save link as

5

• Ram Krishna Purohit, MD, Jay Gopal Sharma, MS, Sarabjeet Singh, DGO, and Dipak Kumar Giri, MD:
• Vaginal Hysterectomy by Electrosurgery for Benign Indications Associated with Previous Cesarean Section
• JOURNAL OF GYNECOLOGIC SURGERY Volume 29, Number 1, 2013, Pages: 07 - 12 © Mary Ann Liebert, Inc.DOI: 10.1089/gyn.2012.0082
• View this document:To download right click and select save link as

6

• Ram Krishna Purohit, MD, Jay Gopal Sharma, MS and Shikha Joshi, MD:
• Adnexectomy During Vaginal Hysterectomy for Benign Indications Using Bipolar Hemostasis of Lateral Pedicles and Transvaginal Adnexa Mobilization
• JOURNAL OF GYNECOLOGIC SURGERY Volume 31, Number 2, 2015 Pages: 86 - 91 © Mary Ann Liebert, Inc.DOI: 10.1089/gyn.2014.0088
• View this document:To download right click and select save link as

7

• Ram Krishna Purohit, MD, Jay Gopal Sharma,Devajani Meher,Sanjay Raosaheb Rakh and Surya Malik:
• Completion of vaginal hysterectomy by electro surgery using anteroposterior approach in benign cases faced with obliterated posterior cul-de-sac
• View this document:To download right click and select save link as

8

• Dr.Ramkrishna Purohit,Dr.Jay Gopal Sharma,Dr.Devajani Meher,Dr.Sanjay Raosaheb Rakh,Dr.Minal Choudhary:
• A laparovaginal strategy to avoid bladder injury during laparoscopic-assisted vaginal hysterectomy in cases with ventrofixed uterus following previous cesarean section
• International Journal of Women’s Health
• View this document:To download right click and select save link as

9

• Ramkrishna Purohit, Jay Gopal Sharma, Devajani Meher, Mohammed Mahmoud Samy, Rupam Sarkar
• A Combined Strategy of Vaginal Hysterectomy by Electrosurgery with Post Hysterectomy Check Laparoscopy in Benign Indications Associated with Known or Suspected Concomitant Pelvic Disease: A Retrospective Study. PubMed, SCI, Scopus, ESCI, PMC indexed
• www.fortunejournals.com