August 2008, Vol. 14, No. 2
SAJOG
RESEARCH ARTICLE
70
Implications of performing laparoscopicassisted vaginal hysterectomy versus
abdominal hysterectomy on suitable
patients in a South African hospital
setting
Andreas Chrysostomou, MD, FCOG, MMed
Department of Obstetrics and Gynaecology, Johannesburg Hospital and University of the
Witwatersrand, Johannesburg
Objectives. To compare short-term clinical results with standard abdominal hysterectomy (AH), to investigate
the feasibility of registrar training in laparoscopic-assisted vaginal hysterectomy (LAVH), and to investigate the
impact of laparoscopy in changing the route of hysterectomy in women assessed as being unsuitable for vaginal
hysterectomy (VH) on clinical examination.
Methods. 104 women scheduled for AH for benign uterine conditions were enrolled in the study. Criteria for
inclusion were uterine size ≤14-week pregnancy, width ≤9 cm and length ≤14 cm. Clinical ovarian pathology and
uterine prolapse were criteria for exclusion. Patients were divided into two groups matched with respect to age,
parity, previous pelvic surgery and indications for hysterectomy. Laparoscopic assessment of the pelvic organs
before VH was performed in 58 of the 104 patients in the study, and 46 patients had AHs without laparoscopic
assessment.
Results. VH facilitated by laparoscopic assessment was successful in all cases, with no need to convert to the
abdominal route. The time required for LAVH compared with AH was longer, but not significantly so (mean 59.3
minutes v. 57.2 minutes). Blood loss was found to be less with LAVH than with AH, and postoperative pain and
need for analgesia were significantly less (p<0.001). Postoperative hospital stay was significantly shorter in the
LAVH group (2.4 days) than in the AH group (3.9 days) (p<0.001).
Conclusions. There was shorter hospital stay, less need for analgesia, less intraoperative bleeding and better
patient satisfaction with LAVH. Moreover, LAVH decreased the number of hysterectomies done abdominally.
Since the first case report of laparoscopic hysterectomy
(LH) by Reich et al.,1 this minimally invasive technique
is being increasingly utilised. The advantages of LH are
similar to those of vaginal hysterectomy (VH), including
minimal postoperative discomfort and less need for
analgesics, a shorter stay in hospital and quicker return to
normal daily activities. There are also fewer postoperative
complications, and hospital costs are reduced.2-4
Hysterectomy is one of the most commonly performed
operations in developed countries. It is estimated
that approximately 20% of women living in England
and Wales will have undergone a hysterectomy before
the age of 55. 5 Most surgeons perform up to 80% of
procedures by the abdominal route. 6 This can in part
be explained by personal preference, but is mainly due
to lack of training and experience leading to reluctance
to perform VH in nulliparous women in the presence of
uterine enlargement or in women with previous pelvic
surgery or previous caesarean section. The above factors
should not be considered contraindications to VH, and
there are publications that support this view. 7,8 The
rationale for LH is to convert an abdominal hysterectomy
(AH) into a laparoscopic/vaginal procedure and thereby
reduce trauma and morbidity. In the USA before the
introduction of LH, only 23% of women under the age of
60 underwent VH. The introduction of LH increased the
proportion of VHs to 33%.9
In South Africa there is a lack of nationwide statistics.
The year before the initiation of this study, VHs comprised
only 9.8% of all hysterectomies at Johannesburg Hospital
(Fig. 1). This situation was attributed to inadequate
training, patient ethnic group, previous surgery,
nulliparity and absence of uterine prolapse. Ethnicity
may explain the relatively low rate of VH in our country.
In an epidemiological study performed in the USA the
authors found that 75% of hysterectomies performed in
African-Americans were for uterine fibroids, which are
a contraindication to VH. Inadequate training may have
produced a generation of gynaecologists who are not
happy to perform VH in the absence of prolapse in spite
of the well-documented advantages of VH in comparison
with AH.
Study group
The study group comprised women admitted for AH for
benign uterine conditions who were selected to undergo
LAVH, provided they met the following criteria:
• Uterine size not exceeding a 14 weeks pregnant uterus
on clinical examination.
• Uterine size not to exceed 14 cm length and 9 cm
width on ultrasound examination.
• No evidence of ovarian enlargement or any indication
for oophorectomy.
• Nulliparous women without uterine prolapse, women
with previous pelvic surgery and women with previous
caesarean section were included in the study group.
Any patient who was considered to be suitable for VH on
routine standard clinical assessment by a consultant was
excluded. All patients booked into the author’s unit for
AH were entered into the study group provided they met
the inclusion criteria described above. The laparoscopic
assessment was carried out by the author in all cases,
and all the VHs were performed by registrars in training
under the supervision and with the assistance of the
author.
Control group
Controls were selected from gynaecological units
not participating in the study. They were matched
with respect to age, parity, previous pelvic surgery
and indications. All the AHs were carried out by the
registrars in training at Johannesburg Hospital under the
supervision and with the assistance of the consultants.
Unfortunately it was not practically possible for the same
surgeon to operate on all the control patients. However,
this limitation was noted when comparing the outcomes
in the two groups.
LAVH
Before proceeding to VH a laparoscopic assessment
of the pelvis and pelvic organs was performed. The
laparoscopic component of VH includes assessment of
the pelvic organs, release of adhesions and treatment of
endometriosis where necessary (up to stage I of LAVH).
Provided the entry conditions were confirmed and any
adhesions could be released laparoscopically, VH was
Data analysis
Comparative parameters were tested for significant
differences using Student’s t-test for normally distributed
continuous data and the Mann-Whitney test for nonparametric data. A p-value of <0.5 was considered to be
statistically significant.
SAJOG
This comparative study investigated LAVH (study group)
against AH (control group). It was approved by the Ethics
Committee of the University of the Witwatersrand.
All patients received prophylactic antibiotics during
surgery.
August 2008, Vol. 14, No. 2
Patients and methods
performed. The laparoscope was left in position to assess
the progress and any complications of the procedure.
Following VH and the closure of the peritoneum and
vaginal vault, laparoscopy was performed in all cases to
assess haemostasis and flush out blood and debris.
Outcome measures
VHs facilitated by prior laparoscopic assessment and
AHs were compared as follows:
1. Operative parameters and complications
• Operation time (minutes).
• Specimen weight, to demonstrate any difference in
uterine size between groups.
• Blood loss intraoperatively (estimated) and need
for intraoperative blood transfusion. Blood loss was
assessed by best estimated volume loss.
• Necessity of converting the VH to an abdominal
approach.
• Operative complications.
2. Short-term clinical outcome
• Hospital stay (days).
• Postoperative need for blood transfusion. If blood
transfusion was required, the volume of blood given
was recorded.
• Postoperative pain – the pain scale is a simple 10 cm
visual analogue scale, which has been used previously
and is easily comprehended by patients.
• Amount, frequency and type of analgesia required.
• Febrile morbidity and the need for antibiotics.
The laparoscopic part of the study did not require
additional funding. The gynaecological theatre was
equipped with the necessary laparoscopic instruments
to perform laparoscopic surgery.
Results
There were 58 cases in the study group (LAVH) and
46 in the control group (AH). All VHs facilitated by
laparoscopic assessment were successful, with no need
to convert to the abdominal route. Patient characteristics
at inclusion, the indications for hysterectomy and the
weights of the uteri were similar in the two groups
of patients (Tables I and II). No cases from the study
group were excluded. Seven patients in the LAVH group
required adhesiolysis and 2 were found to have minimal
71
Table I.
August 2008, Vol. 14, No. 2
SAJOG
Age (yrs)
Weight of
uterus (g)
Parity
72
Table II.
was recorded in 7 patients in the AH group but none in
the study group. Of women who underwent LAVH, 74%
(43 of 58) had at least one of the five conditions (a large
uterus, nulliparity, previous caesarean section, previous
laparotomy and fibroids protruding through the cervix)
that are generally considered relative contraindications
to VH.
Characteristics of the study and
control groups (means (ranges))
LAVH
(N=58)
44.3 (28 - 56)
AH
(N=46)
42.7 (28 - 60)
151.4 (86 - 286)
2.4 (0 - 5)
135.2 (65 - 280)
2.6 (0 - 5)
The number of VHs performed at Johannesburg Hospital
since 1995 and the impact of the study on VH numbers
is shown in Fig. 1. The proportion of VHs increased from
9.8% of all hysterectomies at the beginning of the study
period (July 2001) to 19.2% at completion of the study
(December 2004).
Indications for hysterectomy in the
study and control groups (patients
could have more than one indication)
Multifibroid uterus
Chronic pelvic pain
Menorrhagia
Polyp protruding through cervix
Cervical intra-epithelial neoplasia III
Severe dysmenorrhoea
Deep dyspareunia
Endometrial hyperplasia
Mentally retarded
LAVH
(N=58)
AH
(N=46)
36
31
27
4
4
7
5
0
0
30
23
22
1
8
3
2
1
1
Discussion
This study demonstrated that all patients admitted for
AH who met the inclusion criteria set up for the study
could be operated on vaginally after being assessed
laparoscopically. The benefit of laparoscopic assessment
is that, where necessary, adhesions can be released, the
ovary visualised and endometriosis treated. Although
LAVH necessitated slightly longer theatre time than
AH, this was more than compensated for by the welldocumented postoperative benefits of shorter recovery
time and hospital stay and less pain.2-4
endometriosis necessitating ablation. No gross ovarian
abnormality was found.
Hysterectomy is the most common gynaecological
operation, and the vaginal route is preferable. However,
The time required for surgery was not significantly longer
for LAVH than for AH (59.3 minutes v. 57.2 minutes).
Postoperative hospital stay and convalescence were
significantly shorter in the LAVH group, with a hospital
stays of 2.4 days for LAVH and 3.9 days for AH. There
was significantly less postoperative pain and less need
for analgesia in the LAVH group. Blood loss during the
procedure was significantly less in the LAVH group than
in the AH group (Table III), although no patient received
a blood transfusion. One major complication occurred in
the AH group and none in LAVH group (Table IV). This
was deep-vein thrombosis presenting with pyrexia and
resolving with antibiotics and enoxaparin. A temperature
above 38ºC more than 24 hours after the operation and
necessitating intravenous administration of antibiotics
Fig. 1. Vaginal hysterectomies performed at
Johannesburg General Hospital (as a percentage of
all hysterectomies), 1995 - 2004. The study period
was July 2001 - December 2004.
Table III.
Operation time and postoperative course in the study and control groups (mean (range))
Operation time (min)
Hospital stay (days)
Median postoperative pain as assessed by VAS
Number of opiate injections required
Estimated blood loss (ml)
*Student’s t-test.
†Mann-Whitney test.
VAS = visual analogue scale.
LAVH
N=58
AH
N=46
p-value
59.3 (40 - 90)
2.4 (2 - 5)
Day 1: 3 (2 - 5)
Day 2: 1 (0 - 3)
2.4 (2 - 4)
152 (50 - 300)
57.2 (40 - 90)
3.9 (3 - 5)
6 (4 - 7)
4 (2 - 5)
4.2 (3 - 5)
254 (75 - 750)
0.60*
<0.001*
<0.001†
<0.001†
<0.001*
<0.001†
Table IV.
Complications in the immediate postoperative period in the study and control groups
LAVH (N=58)
Major
The presence of adhesions and endometriosis, locations
of fibroids and the feasibility of VH in the absence of
uterine prolapse can in my view best be assessed by
laparoscopy. The results of this study are in agreement
with those of Kovac et al., 10 who demonstrated that
laparoscopy before AH made it possible for 91.3% of
women to undergo an uncomplicated VH. In our study
all cases in which AH was planned went on to VH and in
no case was it necessary to convert from VH to AH.
Our results are not in agreement with some studies, which
showed that LH significantly increase theatre time,11,12 as
it is not so much the laparoscopy itself that increases the
operating time but the amount of hysterectomy performed
laparoscopically as opposed to vaginally. Laparoscopic
surgery should be converted to a vaginal procedure as
early as possible (e.g. after adhesiolysis, assessment of
the ovaries and location of fibroids, as in our study).
Nothing is gained by continuing dissection, since this
not only considerably and unnecessarily prolongs the
surgery but also increases the risk of visceral damage
and haemorrhage. In agreement with the above studies,
we found length of hospital stay to be significantly
shorter and the need of analgesia to be significantly less
for LAVH than for AH. Postoperative pain as assessed by
the VAS was less after LAVH than after AH, explaining
the lesser need for analgesia in LAVH group.
0
0
0
0
1
7
0
0
demonstrated that LAVH can be performed safely on
selected patients who would otherwise be scheduled for
AH. The finding of less operative bleeding in the LAVH
group is in agreement with another study. 14 We did
not perform routine postoperative measurement of the
haemoglobin (Hb) concentration to document the above
statement, but none of the patients received a blood
transfusion. However, the fact that we did not routinely
measure the postoperative Hb may be considered a
weakness of the study, as objective proof of different
amounts of blood loss could not be documented.
Although cost analysis and patient satisfaction are out
of the scope of this study, shorter hospital stay is likely
to save costs. Patients who had had LAVH reported
returning to their normal daily activities sooner and
having a better quality of life than patients who had
had AH.
There were no major complications in the two groups,
other than one deep-vein thrombosis in a woman who
underwent AH. Seven patients had pyrexia at 24 hours
after AH necessitating antibiotic treatment, which is
regarded as a minor complication. The fact that we
found no case of pyrexia in the postoperative period in
the LAVH group is in agreement with another study15
that found less postoperative febrile morbidity after VH
compared with AH.
There is no specific cut-off age for removal of the ovaries
in our institution. In this study removal of the ovaries
was common among women over 45 having an AH and
almost universal among those over 47. In the LAVH
group we managed to remove the ovaries vaginally in
only 3 out of 10 women over the age of 45. This may be
considered as a limitation of this study. The 7 women
whose ovaries we failed to remove were not at high risk
for ovarian malignancy, and laparoscopic assessment
showed their ovaries to be macroscopically normal.
Removal of the ovaries in order to prevent ovarian cancer
remains controversial for women not at high risk. It is
estimated that about 200 oophorectomies will be needed
to avoid 1 case of ovarian cancer.13
There are reports that uteri up to a 14-week size can
be removed vaginally, with the proviso that it may be
necessary to convert to AH, 16 or at least that a VH can
be attempted while the patient is under anaesthetic. 17
In my view this may lead to unacceptable complications
such as haemorrhage necessitating blood transfusion,
pose a risk of bladder and bowel damage, increase
theatre time and mean disappointment for the patient.
If there is doubt about the likelihood of successful VH
it may be wiser to proceed directly to AH. A skilful
vaginal surgeon can remove large uteri; one surgeon
has reported removing uteri of 1 kg and larger.18 Such
cases are not appropriate for the training of registrars
in vaginal surgery or VH. Also, we should not abandon
the laparoscope and schedule the next woman with a
14-week uterus for a VH if there is any doubt that this
procedure will be successful. LAVH may offer a transition
into more aggressive vaginal surgery.
The results of this case control study, with relatively
small numbers of patients who were not randomised,
In this study laparoscopic assessment after performing
VH may have improved haemostasis, with flushing out
SAJOG
the vaginal procedure seems to be ignored by most
surgeons, resulting in an extremely high rate of AH.6 The
main indication for LH is to convert AH into a vaginal
operation, or a difficult VH into an easy one.
0
0
0
0
0
0
0
1
August 2008, Vol. 14, No. 2
Minor
Haemorrhage necessitating blood transfusion
Urinary tract damage
Pulmonary embolism
Bowel damage
Deep-vein thrombosis
Pyrexia requiring antibiotics
Wound sepsis
Wound erythema
AH (N=46)
73
August 2008, Vol. 14, No. 2
SAJOG
of clots and blood preventing vault haematoma and
febrile morbidity in the immediate postoperative period.
According to Marshall and Smith,19 the amount of blood
clots that remain in the pelvis after VH which has seemed
to be dry and haemostatic is surprising. Flushing out the
clots may have been beneficial for the patients in our
study.
74
One of the limitations of the study was that the same
surgeon was not able to do all the control procedures. The
outcome of the study was influenced by the experience of
the registrars in both groups and also by the experience
of the consultants in the control group. A major difficulty,
not only for this study but for any randomised trial in
surgery, is the uncontrollable effect the surgeon has on
the outcome.
The American College of Obstetricians and
Gynecologists 20 guidelines recommend that choice
of the route of hysterectomy should depend on the
patient’s anatomy and the surgeon’s experience. If the
gynaecologist did not perform enough VHs during training,
he or she may be inclined to perform hysterectomy by
the abdominal route when it could safely be performed
vaginally. Fear of litigation should complications arise is
another factor affecting choice of procedure.
In 1998 the Royal College of Obstetricians and
Gynaecologists21 recognised that the route of hysterectomy should be audited to determine the optimal rate
of VH. The audit should include surgeon preference,
degree of descent of the uterus and need and opportunity for more training in vaginal surgery. In South Africa
there is a lack of national statistics, but at Johannesburg
Hospital the rate of VH was 9.8% a year before the beginning of the study and reached 19.2% by the end (Fig. 1),
which is significant if one takes into consideration that
the vast majority of our patients are black Africans with
benign conditions such as uterine fibroids.
The fact that all the VHs in this study were done by
registrars under the author’s supervision and with his
assistance highlights the important issue of training
and teaching. There is a need nationally for more
training in VH as well as other vaginal procedures to
produce a new generation of vaginal surgeons capable
of performing VHs in the absence of uterine prolapse
for selected benign conditions, as there are too few
opportunities to encounter uterovaginal prolapse to
allow adequate training in vaginal surgery. This study
provides evidence of the feasibility of registrar training
in VH using laparoscopic assistance.
Registrars in teaching hospitals must receive more
training in VH. The present number of VHs that a
registrar is required to perform before he or she can
attempt the College of Medicine examinations is not
sufficient to ensure competency in this procedure in
specialist practice. All possible efforts must therefore
be employed for registrars to get more exposure and
training in VH.
Conclusion
Challenging the routine contraindications to VH by the
use of laparoscopic assessment can lead to an increased
number of VHs. Deficient registrar training in VH is a
major problem in our postgraduate programme, and this
study provides evidence of an additional opportunity to
allow registrars to safely perform more VHs.
1. Reich H, De Caprio J, McGlynn F. Laparoscopic hysterectomy. J Gynecol Surg 1989;
5: 213-216.
2. Garry R. Various approaches to laparoscopic hysterectomies. Curr Opin Obstet
Gynecol 1994; 6: 215-222.
3. Dickec RC, Greenspan J. Strauss LT, et al. Complications of abdominal and vaginal
hysterectomy among women of reproductive age in the United States. Am J Obstet
Gynecol 1982; 144: 841-848.
4. Kovac SR. Hysterectomy outcomes in patients with similar indications. Obstet
Gynecol 2000; 95: 787-793.
5. Coulter A, McPherson K, Vessey M. Do British women undergo too many or too few
hysterectomies? Soc Sci Med 1988; 27: 987-994.
6. Vessey MP, Mackintosh V, McPherson K, Coultez A, Yeates D. The epidemiology of
hysterectomy: Findings in a large cohort study Br J Obstet Gynecol 1992; 99: 402407.
7. Raymond CD, Howard T, Stephan C. Challenging generally accepted
contraindications to vaginal hysterectomy. A technique for vaginal hysterectomy.
Am J Obstet Gynecol 2001; 184: 1386-1391.
8. Porges RF. Changing indications for vaginal hysterectomy. Am J Obstet Gynecol
1980; 136: 153-158.
9. Wattie A., Cohen SB, Salvaggi L. Laparoscopic hysterectomy. Curr Opin Obstet
Gynecol 2002; 14: 417-422.
10. Kovac SR, Cruikshand SH, Petto HF. Laparoscopy-assisted vaginal hysterectomy.
J Gynecol Surg 1990; 6: 185-193.
11. Nezhat F, Nezhat C, Gordon S, Wilkins E. Laparoscopic versus abdominal
hysterectomy. J Reprod Med 1992; 37: 247-250.
12. Olsoson J, Ellström M, Hahlin M. A randomised prospective trial comparing
laparoscopic and abdominal hysterectomy. J Obstet Gynaecol 1996; 103: 345-350.
13. Rees MCP. Menopausal menstrual problems. In: McPherson A, Walter D, eds.
Women’s Health. Oxford: Oxford University Press, 1997: 320-321.
14. Howard FM, Sanchez RA. A comparison of laparoscopic assisted vaginal
hysterectomy and abdominal hysterectomy. J Gynecol Surg 1993; 9: 83-90.
15. Ellstöm M, Ferraz-Nunes J, Hahlin M, Olsson JH. A randomised trial with costconsequence analysis after laparoscopic and abdominal hysterectomy. Obstet
Gynecol 1998; 91(1): 30-34.
16. Varma R, Tahseen S, Amali U. Lokugamage AU, Kunde D. Vaginal route as the norm
when planning hysterectomy for benign condition: Change in practice. Obstet
Gynecol 2001; 4: 613-616.
17. Sheath SS. The scope of vaginal hysterectomy. Eur J Obstet Gynecol Reprod Biol
2004; 115: 224-230.
18. Magos A, Bournas N, Sinba R, Richardson RE, O’Connor H. Vaginal hysterectomy
for the large uterus Br J Obstet Gynaecol 1996; 103: 246-251.
19. Marshall L, Smith JR. Laparoscopically assisted vaginal hysterectomy. In: Operative
Laparoscopy. The Master’s Techniques in Gynaecological Surgery. 2nd ed.
Philadelphia: Lippincott-Raven Publishers, 1998: chapter 16, 217-220.
20. American College of Obstetricians and Gynecologists. Quality Assurance in
Obstetrics and Gynaecology. Washington, DC: ACOG, 1989.
21. Royal College of Obstetricians and Gynaecologists. Effective Procedures in
Gynaecology Suitable for Audit. London: RCOG, 1998.
Manual Vacuum Aspiration:
A Preferred
Alternative
Method
to D&C
A Preferred
Alternative
to D&C
MVA PROCEDURE COST EFFICIENT
Manual Vacuum Aspiration (MVA) is a uterine evacuation
and endometrial sampling technique backed by over
25 years of clinical research demonstrating its effectiveness
and safety advantages over sharp curettage (D&C). This
innovative technology consists of plastic Cannulae (the
new Ipas EasyGrip®) connected to a manual vacuum aspirator (Ipas MVA Plus®).
Leading international health organisations such as the World Health
Organisation (WHO) and the International Federation of Gynaecology
and Obstetrics (FIGO) recognise MVA as “a preferred method of evacuation of the uterus”, affirming that “dilatation and curettage should
only be used if the preffered methods are not available”. Health-care
professionals and organisations worldwide attest to the safety, quality
and effectiveness of MVA for uterine evacuation.
THE MANUAL VACUUM ASPIRATOR:
The Ipas MVA instrument consists of a
locking,
handheld
60ml aspirator that
attaches to various
sizes of plastic flexible
cannulae. Use of MVA
requires little additional equipment or
changes to existing
infrastructure. The
manual vacuum source
requires no electricity and is therefore truly portable. Furthermore,
MVA typically involves a lower level of pain control than sharp curettage, thereby avoiding the time, expense and increased risks associated
with general anaesthetic or heavy sedation. Such versatility facilitates
decentralised service delivery and makes MVA ideal for use in a wide
range of settings, including hospitals, clinics, private practices and other
outpatient facilities. The relative simplicity of the procedure allows for a
wide range of providers, from obstetricians, gynaecologists and general
practitioners, to suitably qualified registered nurses and midwives to be
skilled in MVA technology.
USES AND ADVANTAGES OF MVA TECHNOLOGY:
1.
2.
3.
4.
5.
6.
7.
8.
9.
Uterine evacuation.
Retained placental products.
Threatened or imminent abortion.
Inevitable abortion.
Missed abortion.
Incomplete abortion.
Infected abortion.
Anembryonic pregnancy.
Hydatidiform mole.
ADVANTAGES OF MVA IN TREATMENT OF INCOMPLETE ABORTION
1.
2.
3.
4.
5.
6.
7.
8.
Requires only slight dilation and aspirates gently.
Lower risk of complications.
Lower cost of services.
Lower resource use.
Decreased need for hospitalisation.
Outpatient procedure.
Local anaesthesia
Patients recover and return home more quickly.
The reduction in risk of uterine perforation provides the peace of mind of
a safer procedure for both patient and provider, and the improved quality and consistency of tissue samples, assures a quick and accurate diagnosis.
•
•
•
•
Adopting MVA for the provision of uterine evacuation and
endometrial sampling procedures is proven to facilitate
improvements in both clinical and management practices.
Benefits include:
• Increased efficiency of patient flow, resulting in less waiting time for patients.
Conservation of resource utilisation, allowing providers and their facilities to apply valuable resources to other areas of need or to expand
services.
Reduction of patient stay, permitting patients to enjoy the comforts of
home.
Reduction in facility costs per procedure.
MVA technology enables endometrial biopsy to be done in the doctor’s
office
MVA technology can play a very important role in helping providers
offer safe, effective gynaecological care that is acceptable and responsive
to women. Because the suction produced by MVA is quieter than that of
Electric Vacuum, some providers have noted that their patients exhibit
less anxiety. In addition, MVA often requires less cervical dilatation than
sharp curettage, resulting in a more comfortable procedure.
SAFE AND EFFECTIVE
Through the manufacture and distribution of MVA,
Ipas is committed
to
equipping
h e a l t h c a r e
providers with a
safe and effective
technology for uterine evacuation and
endometrial sampling
procedures. MVA offers distinct advantages over sharp curettage for
providers, for healthcare facilities, and for the women they serve. MVA
is a well-established technology, and its potentially profound impact on
the quality of reproductive healthcare services makes it an innovative
and essential medical device.
NEW IPAS EASYGRIP® THE COMPANION TO THE MVA PLUS®
The new cannulae are specifically designed for use with the 60ml Ipas
double-valve aspirator or the new Ipas MVA Plus® to form the Ipas
MVA system for performing uterine evacuation procedures.
High Quality latex-free plastics used in the manufacture of Ipas
EasyGrip® cannulae provide the tactile response of a rigid curette with
the gentle probe of flexible cannulae.
Available in sizes 4 -12mm, Ipas EasyGrip® cannulae utilize permanently affixed bases, which eliminate the need for adapters to connect to the
aspirator. These bases are colour-coded by size for rapid differentiation
and are constructed with ‘wings’ to facilitate easy insertion and removal
from the aspirator.
Ipas EasyGrip® cannulae are individually wrapped and are sterilised
with ethylene oxide gas, remaining sterile as long as the wrapper is intact
or until the expiration of the three-year shelf life.
US Patent and Trademark Office Reg. No.: Ipas MVA Plus® 2,907,186
Ipas Easygrip® 2,768,302
Contact Details:
Ipas South Africa, PO Box 2121, Parklands, 2155
+27 11 880 4104 (t), +27 11 447 8599 (f)
ipassa@ipas.org (email), www.ipas.org