For doctors at Government Raja Sir Ramaswamy Mudaliar (RSRM) Lying-in Hospital, Royapuram, a hysterectomy was never too complicated until 39-year-old C. Kavitha approached them last week.
A resident of Kumbakonam, Ms. Kavitha suffered from meningomyelocele — cyst of the covering of the spinal cord — and underwent surgery as a newborn.
However, her lower limbs were paralysed. Almost a year ago, she developed problems due to uterus prolapse.
“She is a paraplegic and has not been able to lie on her back from childhood. She has to lie on her stomach to sleep. She moves around using her hands. Her uterus prolapsed and ulcerated due to the pressure,” said A.L. Meenakshi Sundaram, dean of Stanley Medical College Hospital.
Doctors said Ms. Kavitha also developed difficultly passing urine.
She approached private hospitals in Kumbakonam and Thanjavur but did not get any help as the procedure was both surgically and anaesthetically challenging owing to her condition, said Dr. Sundaram.
“We could not administer spinal anaesthesia because she suffered a spinal deformity and could not lie in a lateral position. Instead of using a five-minute muscle relaxant drug to intubate her, we used a 25-minute relaxant drug, as the former could have resulted in a cardiac arrest and put her life at risk. Her position was a real challenge,” he said.
A team of anaesthetists led by Dr. Sundaram, along with R. Kundavi Devi, chief anaesthetist, RSRM, and surgeons V. Kalaivani, medical superintendent of RSRM, and T.S. Meena, professor of obstetrics, performed vaginal hysterectomy with repair of the pelvic floor muscle, on Tuesday.
“The operating table was adjusted in such a way that she was sitting in a semi-reclined position. The anaesthetist administered general anaesthesia standing on a stool as her head was tilted up to 45 degrees,” said Dr. Kalaivani.
Dr. Meena said Ms. Kavitha’s legs were positioned using pillows. “Usually, the legs are strapped to rods — a position called lithotomy. We had to be very careful in Kavitha’s case. We slightly flexed her legs.”
In post-operative care at the intermediate care unit of RSRM, Ms. Kavitha said the uterus prolapse had made her movement extremely difficult.
“I was used to doing all work, including cooking and washing clothes, myself. I feel better now after the surgery,” she said.