Non-Descent Vaginal Hysterectomy (NDVH): Safe & Scarless Option of Uterus Removal

Usha Nair (47) got an ultrasound done  on the recommendation of her gynecologist when she experienced bleeding with multiple fibroids. On the basis of her symptoms and history of suboptimal response to medical treatment, tests and examination, Dr. Swati Sinha, Consultant Obstetrician – Gynecologist at Sitaram Bhartia Hospital suggested an  NDVH.

Unaware to what this meant, Usha quickly asked,

“What is NDVH surgery? What is the full form of NDVH?”

In response, Dr. Swati informed her, “ NDVH or non-descent vaginal hysterectomy means  the removal of the uterus from the woman’s body through the vagina instead of the abdomen.”

Is a hysterectomy a major surgery?

Like any surgery, a hysterectomy is a major operation.

“We recommend a hysterectomy in conditions where medical and non-surgical treatments have not helped and only when women have completed their family and do not want more children.”

What are the types of hysterectomy?

There are three types of hysterectomy such as

  • Total hysterectomy wherein the uterus and cervix are removed
  • Subtotal hysterectomy in which only the uterus is removed
  • Panhysterectomy in which uterus, both tubes and ovaries are removed

How is the uterus removed by surgery?

The doctor went on to elaborate that a hysterectomy can be performed in three ways:

  • abdominally
  • vaginally and
  • laparoscopically

In an open abdominal hysterectomy, an 8-10 cm cut or incision is made on the abdomen and the reproductive organs are then removed through the large incision.

When laparoscopic instruments are used to remove the uterus through small incisions, it is called a laparoscopic hysterectomy.  A vaginal hysterectomy is usually done in the case of uterine prolapse-meaning the uterus has descended into the vagina.

Upon hearing about incisions, Usha asked “does a vaginal hysterectomy leave scars?”

Can you have a hysterectomy without a scar?

A non-descent vaginal hysterectomy (NDVH) is a type of vaginal hysterectomy that can be performed in the case of a non-prolapsed uterus. Since the surgeon removes the uterus through the natural orifice/ opening (vagina) in the body, it does not leave any visible scars. 

It is for this reason that NDVH is sometimes referred to as a scarless hysterectomy or scarless surgery.

Which surgery is best for uterus removal?

Vaginal hysterectomy when technically possible is the best route for the removal of uterus as it is done through a natural opening and there are no cuts or incisions. But when the vaginal route if not technically possible, then the laparoscopic route is preferred as it involves very small incisions on the abdomen.

When the uterus is very large or if there is suspicion of malignancy, then sometimes even a laparoscopic hysterectomy may be difficult and an open surgery is preferred.

In which conditions can a non-descent vaginal hysterectomy be performed? 

Your gynecologist may suggest this procedure in case of

“A non-descent vaginal hysterectomy (NDVH) requires skill, expertise and experience to remove the uterus through the natural hole in the vagina.”

Usha wanted to know the pros and cons of the procedure before considering it.

Advantages of NDVH surgery

NDVH in gynaecology is a common procedure that is nearly painless and smoother than a laparoscopy. The benefits of NDVH are:

  • No stitches/scars, meaning it is a scarless surgery
  • Few complications
  • Short hospital stay and fast recovery
  • Less pain after surgery
  • Less expensive than other hysterectomies

Usha wanted to know how long it would take for her to return to her desk job after the surgery.

How long does it take to recover after NDVH?

You will need to stay in the hospital for 2 days. After your hospital stay, you will be able to go back home without requiring support.

“You can resume your daily chores, walk or climb stairs as usual.”

NDVH surgery complications include risks of bleeding or infection that can be expected with any other surgery.

“In the hands of an experienced gynecologist, you should have no reason to worry.”

Now free from doubt, Usha wanted to know if there were any instructions to keep in mind while getting ready for the procedure.

How do I prepare for NDVH?

  • Get a pre-anesthetic check up by meeting the anesthetist with all your reports
  • Take medicine as advised by your surgeon and anesthesiologist
  • Avoid milk or food 8 hours prior to the scheduled time of surgery/procedure. You may drink water till 3 hours prior to the surgery/procedure.
  • Contact your doctor immediately if you have a cough, cold, nasal congestion, fever, vomiting, and/or any other discomfort before admission.
  • Ensure you bathe with soap and water, and wash your hair with shampoo before admission. Cut your finger and toe nails.
  • On the day of the surgery, avoid wearing any jewellery/make up like nail paint, eye liner
  • Bring the necessary documents on the day of admission as recommended by hospital staff.

With a thorough understanding, Usha felt ready to undergo surgery. She discussed the procedure with her husband and children and then scheduled NDVH surgery for the following week.

She was discharged within two days and came in for a follow up visit shortly after.

Conclusion

“I was afraid when the doctor mentioned a non-descent vaginal hysterectomy but the way she explained the procedure and why it was being done gave me clarity on what to expect. I experienced pain only for 24 hours after the surgery and thereafter, didn’t face any discomfort. I’ve resumed my routine and feel a lot better,” Usha completed.

This article was written in February 2020 and has been updated with editorial inputs from Dr. Swati Sinha, Consultant, Obstetrics and Gynecology at Sitaram Bhartia Hospital.

Dr. Swati Sinha, MBBS, Maulana Azad Medical College, New Delhi (1996); MD (Obstetrics & Gynaecology), Lady Hardinge Medical College, New Delhi (2001); MRCOG Part 1 (October 2010)
Experience: 20 years

Come in for a complimentary consultation with Dr. Swati. Please call on +91 9871001458 to schedule your appointment.

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