title: Modified approach to vaginal hysterectomy without initial colpotomy.
abstract: OBJECTIVE
  To evaluate the surgical technique and outcomes of women undergoing the modified approach to vaginal hysterectomy at Harbor-University of California, Los Angeles Medical Center from 2000 to 2011. A retrospective chart review was performed of all vaginal hysterectomy cases performed using the modified technique.
  
  
  RESULTS
  There is much evidence in favor of the safety of vaginal hysterectomy over other modes of hysterectomy, such as the lower overall incidence of vaginal cuff dehiscence, shorter hospital stays and faster recovery from surgery. The traditional method of performing vaginal hysterectomy involves early anterior or posterior colpotomy. At times, this may be difficult secondary to a flush cervix, distorted anatomy, and adhesions from prior surgeries or infection. At our teaching institution, however, we have adopted a different technique, initially developed by Dr. Reza Mohajer who is one of our faculty members and co-author of this article, that facilitates ligation of uterine vessels without initial attempt at colpotomy. This enables Ob/Gyn residents to safely and successfully perform vaginal hysterectomies despite large uterine size, nulliparity, flush cervix and previous pelvic surgery.
  
  
  CONCLUSIONS
  Modified approach to difficult vaginal hysterectomy facilitates performance of vaginal hysterectomy without need for initial anterior or posterior colpotomy.
authors.affiliation: aDivision of Female Pelvic Medicine and Reconstructive Surgery bDepartment of OBGYN, Harbor-University of California, Los Angeles Medical Center, Torrance, California, USA.
authors.forename: Azadeh
authors.initials: A
authors.lastname: Rezvan
authors.forename: Jasmine
authors.initials: J
authors.lastname: Pedroso
authors.forename: Reza
authors.initials: R
authors.lastname: Mohajer
authors.forename: Narender N
authors.initials: NN
authors.lastname: Bhatia
mesh_terms: D000328:Adult; D000368:Aged; D020884:Colpotomy / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000379:methods / Q000639:trends; D007902:Length of Stay; D015141:Los Angeles / Q000453:epidemiology; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013529:Surgical Wound Dehiscence / Q000453:epidemiology / Q000517:prevention & control*; D016896:Treatment Outcome