Vaginal Extraction Score - To Predict Successful Vaginal Extraction of an Intact Uterine Specimen Following Laparoscopic Hysterectomy - Indian Scoring System

BACKGROUND: Tissue removal per vaginally in laproscopic hysterectomy can be challenging with large uterine size, nulliparous status, associated ovarian mass/pelvic adhesions/endometriosis; causing increase in operation time, increased blood loss and opting for alternate methods to remove the specimen such as mini-laparotomy, manual morcellation or using a power morcellator, bisection or distortion of the uterine specimen. A careful pre-operative analysis of certain parameters that would influence the easy vaginal extraction of the uterine specimen in TLH is required in order to reduce the rates of conversion and risk of morcellation. OBJECTIVE: To analyze different parameters and create a scoring system to predict the removal of an intact uterine specimen in laparoscopic hysterectomy. METHOD: A prospective observational cohort study was conducted on patients undergoing laparoscopic hysterectomy in Father Muller Medical College, Kankanady in department of OBG over 1 year (Jan-Dec, 2018) irrespective of the indication the extraction of specimen was attempted vaginally, intact/ bisection or coring of uterus was soughted. Various parameters were evaluated based on preoperative history, clinical examination, ultrasound and intraoperative findings and outcome. The final outcome of the uterine specimen during the surgery was assessed and determined as intact or distorted. Potential predictors for an intact specimen was selected. Their cutoff points were derived and based on that a score was derived. RESULT: 100 patients underwent laparoscopic hysterectomy during the study period (Jan- Dec, 2018) ; out of which 73 specimens were extracted vaginally intact, whereas 27 were either bisected or distorted.1) Selection of potential predictors: Using chi square test and independent t test (for continuous variables), pathology (p