Vaginal hysterectomy.
Hysterectomy is the most common non-pregnancy-related surgical procedure performed in the USA. The ratio of abdominal operations to vaginal operations is 3:1, which probably reflects surgeon's experience and practice styles, the absence of clear guidelines for selecting a surgical route, lack of patient knowledge about the options, and inappropriate decision-making. With the trend toward evidence-based and outcome-based practice, the indications and contraindications for abdominal, vaginal, and laparoscopically-assisted hysterectomy must be examined critically. In the author's extensive experience the rates of abdominal, vaginal, and laparoscopically-assisted procedures are 1.9, 88.7, and 9.4%, respectively. Techniques useful in vaginal hysterectomy with or without simultaneous oophorectomy, the pros and cons of simultaneous incidental appendectomy, and methods of protecting the ureter are discussed.
Kovac
S R
SR
Department of Obstetrics and Gynecology, Wright State University School of Medicine, Miami Valley Hospital, Dayton, OH 45409, USA.
D001062:Appendectomy; D000075202:Contraindications; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000379:methods*; D010052:Ovariectomy; D017410:Practice Guidelines as Topic; D014513:Ureter / Q000033:anatomy & histology / Q000293:injuries