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Video Talk
What I have learnt from my mistakes ? Speaker: Shirish S. Sheth
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Description

Trauma to ureter during vaginal hysterectomy (VH) and a feeling of guilt that innovated discovery of a new safe space to get an access to separate an adherent bladder from the cervico-uterine surface in women with history of C. Section(s). ‘A uterocervical broad ligament space’, was first time given to the literature.

Similarly, trauma to the bladder while performing laparoscopic tubal sterilization resulted in discovery of a new clinical sign, the ‘Cervico-fundal sign’ to diagnose uncommon dense adhesions between the lower abdominal wall and the uterocervical surface, including the bladder wall. Pursuance and perseverance with this clinical sign led to the discovery of a sonographic sign to suspect and/or endorse the clinical findings for such suspected adhesions.
Failure at vaginal hysterectomies due to large uterine size, led to the learning that the obtuse angle between the enlarged uterus and the cervix is a better indicator to perform vaginal hysterectomy than an acute angle. This, in turn, inspired the decision to religiously evaluate the uterine volume in decision-making for the management of such cases.

Damaging the rectum while accessing the Pouch of Douglas at a difficult vaginal hysterectomy with left ovarian endometriotic cyst innovated to describe the ‘Dimple sign’. Though uncommon, dimpling of the posterior vaginal wall should be used as a signal of ovarian endometriosis and dense adhesions between the ovary and vaginal wall.

To keep surgical invasion to the minimum, salpingo-oophorectomy, when required, should be performed concurrently at VH and this necessitates safe clamping of the infundibulo-pelvic ligament. This inspired to design an ovarian clamp known as Sheth’s adnexa clamp (Cooper Surgical, USA) and safely perform prophylactic salpingo-oophorectomy or even for benign ovarian cyst at VH. Furthermore, laterally, removal of broad ligament fibroid was possible concurrently at VH to spare from more invasive laparotomy or laparoscopic surgery as wide open vagina towards completion of hysterectomy provides an access to the broad ligament fibroid vaginally for myomectomy.

I feel extremely happy to share whatever I have learnt from my mistakes and/or complications in the form of original contributions to the literature and spare with my colleagues in the best interest of patients.

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