Deciding the route for hysterectomy: Indian triage system.
OBJECTIVE
To review the limitations, major complications, and conversion rates associated with non-descent vaginal hysterectomy (NDVH); and develop a scoring system to predict the possibility of successful NDVH.


METHODS
The risk analysis of conversion rates from vaginal to abdominal route while attempting NDVH was applied to formulate a scoring system for the assessment of successful NDVH. Parameters were selected based on Kovacs guidelines to determine the route of hysterectomy.


RESULTS
From April 2005 to December 2008, NDVH was attempted in 364/1,378 women undergoing hysterectomy for benign conditions (Gp-I). Eight out of 364 cases (2.1 %) either had to be converted to the abdominal route or had major complication. Endometriosis and repeated sections had the highest risk. Scoring system was developed based on the risk analysis. Validity of this scoring system was tested in 1,177 women from January 2009 to September 2012 (Gp-II). 460 women with a score of 16 or less underwent NDVH successfully with a conversion rate of 0.2 %.


CONCLUSIONS
Careful assessment by a simple scoring system can help in deciding the feasibility of performing NDVH.
Department of OBGYN, Tata Main Hospital, Jamshedpur, India ; 8D Road East Northern Town, Bistupur, Jamshedpur, 831001 Jharkhand India.
Alokananda
A
Ray
Department of OBGYN, Max Hospital, Dehradun, India.
Luna
L
Pant
Department of OBGYN, Air Force Hospital, Jorhat, India.
Navneet
N
Magon
Non-prolapsed uterus; Scoring system; Vaginal hysterectomy