This document discusses the history and techniques of vaginal hysterectomy. It provides details on the procedure including patient positioning, instrumentation, surgical steps like incising the vaginal mucosa and entering the pelvic spaces, clamping and suturing of ligaments, and uterine removal. Post-operative complications are also reviewed. The document serves as a reference for gynecologists performing this common gynecological surgery.
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Dr. Rafi Rozan - Obstetrician Specializing in Vaginal Hysterectomy
1. Dr. Rafi Rozan
Obstetrician & Gynecologist
Specialist in Comprehensive Family Medicine
Mastology, Cosmetic & Laparoscopic Gyn.
Medical Technologist
Vaginal Hysterectomy
2. Soranus of Rome (Reign of the Emperor Hadrian)
Berengarius of Balogna (1507)
Grafenberg (1617)
Laumonier (1792)
Baudelocque (Supurative Peritonitis)
Beyerle (asserted that the Uterus was removed)
Bardol, Marc Antonie, Petit de lyon, Widmann, Ramsbotham,
Figuet, Blasius
Midwives (1646 -1824
Johnson, Baxter, Faivre, Zwinger, Winsor, Weber
Paletta (1812 Malignant uterus)
3. Operative techniques
Radical Shauta operation
Shushart incision
Vaginal hysterectomy Prolapsed Hayney (2)
Te Linde Matingly (6)
Mayo (4)
Kapson
Cambel
Tchernstuk Cornil
Doderlein – Kronig
Without prolapse Dick Eclins
4. Introduction
• The technique of operating through the vagina is a prerogative of the
gynecologic surgeon.
• Vaginal surgery is an essential pre requisite in the cultural and surgical
training of a qualified gynecologist.
• Vaginal hysterectomy is a signature operation of the gynecologic
profession, it is the gold standard and the hallmark of surgical
extirpative hysterectomy surgery.
• At minimum a gynecologist should preform at least 25% of
hysterectomies by the vaginal route.
5. Advantages of the vaginal route
• Lower morbidity
• Less pain
• More rapid recovery
• Rapid return to normal activities
• Less consumption of health care dollars
• Less use of resources
• Less hemorrhage
• Shorter hospital stay
• No scars, better cosmetic finish
• Safer
7. Contraindications
• Absolute : There is no absolute contraindication
• Relative : Malignancy
Extremely enlarged uterus
Dense pelvic adhesions
8. Characteristics that can make the
vaginal approach challenging
• Nulliparity
• Increased BMI
• History of pelvic radiation
• Lack of uterine descent
39. REFERENCES
• Aarts JW, Nieboer TE, Johnson N, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane
Database Syst Rev 2015; :CD003677.
• Committee on Gynecologic Practice. Committee Opinion No 701: Choosing the Route of Hysterectomy for Benign
Disease. Obstet Gynecol 2017; 129:e155.
• Zimmerman CW. Vaginal hysterectomy. In: TeLinde's Operative Gynecology, 11, Howard W. Jones III, John A. Rock (Eds),
Wolters Kluwer, Philadephia 2015. p.715.
• Doucette RC, Sharp HT, Alder SC. Challenging generally accepted contraindications to vaginal hysterectomy. Am J
Obstet Gynecol 2001; 184:1386.
• Friedman AJ, Barbieri RL, Doubilet PM, et al. A randomized, double-blind trial of a gonadotropin releasing-hormone
agonist (leuprolide) with or without medroxyprogesterone acetate in the treatment of leiomyomata uteri. Fertil Steril
1988; 49:404.
• Carr BR, Marshburn PB, Weatherall PT, et al. An evaluation of the effect of gonadotropin-releasing hormone analogs
and medroxyprogesterone acetate on uterine leiomyomata volume by magnetic resonance imaging: a prospective,
randomized, double blind, placebo-controlled, crossover trial. J Clin Endocrinol Metab 1993; 76:1217.
• Minaguchi H, Wong JM, Snabes MC. Clinical use of nafarelin in the treatment of leiomyomas. A review of the
literature. J Reprod Med 2000; 45:481.
• Favero G, Miglino G, Köhler C, et al. Vaginal Morcellation Inside Protective Pouch: A Safe Strategy for Uterine Extration
in Cases of Bulky Endometrial Cancers: Operative and Oncological Safety of the Method. J Minim Invasive Gynecol
2015; 22:938.
• Shiota M, Kotani Y, Umemoto M, et al. Indication for laparoscopically assisted vaginal hysterectomy. JSLS 2011; 15:343.
• Lash AF. A method for reducing the size of the uterus in vaginal hysterectomy. Am J Obstet Gynecol 1941; 42:452.
40. Dr. Rafi Rozan
Obstetrician & Gynecologist
Specialist in Comprehensive Family Medicine
Mastology, Cosmetic & Laparoscopic Gyn.
Medical Technologist
Notas do Editor
VH is the preferred route. Surgeons preference for other routes is no longer considered appropriate to avoid vaginal approach.
Allows to change the patient position intraoperatively.
Decrease exposure because of large size
Provides most access and exposure for vaginal delivery because they are least bulky.
Does not allow for change in position intraoperatively.
Steinert retracts the posterior vaginal and peritoneal surface one the posterior peritoneum has been entered
Sims retractor are used with short weight speculum to visualize the cervix
Breisky Retractors are used to back the vaginal side walls
Use to clamp vascular pedicles
Avascular spaces of the female pelvis (Schematic sectional drawing of the pelvis shows the firm connective tissue covering.
The bladder, cervix, and rectum are surrounded by a connective tissue.