October 2006 · Vol. 18, No. 10Vaginal hysterectomy: 6 challenges, an arsenal of solutions
Obesity, fibroids, previous surgeries and other obstacles usually give way to targeted tactics
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Fast Track
Multiparous, morbidly obese women tend to have little or no apical prolapse but lots of vaginal wall redundancy
A spurt of fluid usually marks appropriate entry into the peritoneum
Avoid tissue injury during morcellation by always cutting toward the center
Ureteral injury is less common with vaginal than with abdominal or laparoscopic routes
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Barbara
S.
Levy,
MDOBG Management Board of Editors, Medical Director, Women’s Health Center, Franciscan Health System, Federal Way, Wash
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REMEMBER
Newer codes for vaginal hysterectomy capture the work of removing larger uteri without laparoscopy
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True or false: When it comes to hysterectomy, surgeons tend to use the route that is safest, least invasive, and most economical.
Sadly, the statement is false. Although vaginal hysterectomy tops all 3 categories, it is the least utilized of surgical routes. The number of vaginal hysterectomies may have increased slightly over the past decade, likely due to the incorporation of laparoscopically assisted vaginal hysterectomy into the mainstream and increased practice with the vaginal component, but fewer than 30% of hysterectomies are performed vaginally.
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