Advanced Vaginal Surgery

Gynaecological disorders are often treated through minimally invasive laparoscopic, or open abdominal access surgery, rather than through vaginal surgery.

This book is a guide to vaginal hysterectomy for gynaecologists.

Divided into seven sections, each further sub-divided into a series of case studies, topics cover vaginal hysterectomy in different disorders and circumstances, including uterine debulking, patients who have previously had a caesarean section, previous uterine surgery, adnexal pathology, nullipara, and endometrial cancer. The final section describes special cases.

Authored by an internationally recognised team of experts in the field, the text is further enhanced by clinical photographs and diagrams.

Key points:

• Guide to vaginal hysterectomy (VH) for gynaecologists
• Presented as a series of case studies describing VH procedures for different disorders and circumstances
• Includes section on special cases
• Internationally recognised author team
•  

Table of Contents:

Section 1: Vaginal Hysterectomy with Uterine Debulking Introduction 3 Case 1: Vaginal Hysterectomy (VH) with Uterine Debulking 8 Case 2: Vaginal Hysterectomy (VH) with Uterine Debulking Plus Bilateral Salpingo-oophorectomy (BSO) (CA125: 516) 9 Case 3: Vaginal Hysterectomy with Uterine Debulking Plus Ovarian Cystectomy 10 Case 4: Vaginal Hysterectomy with Massive Uterine Debulking Plus Bilateral Salpingo-oophorectomy (Right Hydrosalpinx) 11 Case 5: Vaginal Hysterectomy with Debulking Plus Bilateral Salpingo-oophorectomy with H/O Two Caesarean Sections 13 Case 6: Vaginal Hysterectomy with Uterine Debulking Plus Bilateral Salpingo-oophorectomy and Laparoscopic Cholecystectomy 14 Case 7: Nullipara: Large Debulking and Adnexectomy 17 Case 8: Nullipara and Obese: Debulking with Bilateral Salpingectomy 19 Case 9: Massive Debulking of Kilogram Uterus with Bilateral Salpingectomy-1 20 Case 10: Massive Debulking of Kilogram Uterus with Bilateral Salpingectomy-2 21 Case 11: Debulking of Large Adenomyoma, Bilateral Salpingectomy-1 22 Case 12: Debulking of Large Adenomyoma, Bilateral Salpingectomy-2 23 Case 13: Large Debulking with Bilateral Salpingectomy for Recurrent Postmenopause Bleeding 24 Case 14: Early Debulking with the Aid of Vasopressin 25 Section 2A: Vaginal Hysterectomy with History of Caesarean Section(s) Introduction 29 Case 15: VH with Left Ovarian Cystectomy 30 Case 16: VH Plus Stress Urinary Incontinence (SUI) Repair 32 Case 17: VH with Uterine Debulking 33 Case 18: VH with Right Ovarian Cystectomy Plus ?Endometrial Hyperplasia 34 Case 19: VH with Left Salpingo-oophorectomy for Ovarian Endometrial Cyst in a Morbidly Obese Patient 35 Case 20: VH with BSO for Right Ovarian Endometriotic Cyst 37 Case 21: VH with BSO for Abnormal Uterine Bleeding (AUB) with History of Caesarean Sections and Rupture Uterus 39 Case 22: VH Plus Vaginal Cuff with BSO for Postmenopausal Bleeder in a Morbidly Obese and Diabetic Patient 41 Case 23: VH with Altered Approach to Vesicouterine Peritoneum (VUP) 42 Case 24: VH in Heavy Cigarette Smoker with H/O Two Classical Caesarean Sections via Midline Vertical Laparotomy 46 Case 25: VH with Uterine Debulking Plus Bilateral Salpingectomy of Tubal Remnants after Four Caesarean Sections and No Vaginal Births 47 Case 26: VH Plus Bilateral Salpingectomy after One Caesarean and No Vaginal Births 48 Case 27: VH with Uterine Debulking after Six Midline Vertical Laparotomies (Five Caesarean Sections and One Ectopic Pregnancy) in a Morbidly Obese Cigarette Smoker 49 Section 2B: Vaginal Hysterectomy with History of Uterine Surgery in Past Case 28: VH in Nullipara with H/O Abdominal Myomectomy 53 Case 29: VH Plus Salpingectomy in Primipara with H/O Abdominal Myomectomy and Recurrent Large Fibroids 54 Contents Prelims.indd 13 10-04-2017 16:55:29 xiv Advanced Vaginal Surgery Section 3: Vaginal Hysterectomy with Adnexal Pathology Introduction 57 Case 30: VH with BSO for Large Bilateral Hydrosalpinx 60 Case 31: VH with Left Salpingo-oophorectomy for Ovarian Endometrial Cyst in Morbidly Obese with Past History of Two Caesarean Sections 62 Case 32: VH with BSO for Left Ovarian Endometrial Cyst and Right Ovarian Teratoma with H/O Two Caesarean Sections 64 Case 33: VH with BSO for Bilateral Ovarian Endometrial Cysts with Positive “Dimple Sign” 66 Case 34: VH with BSO for a Solid Ovarian Tumor 68 Case 35: VH with BSO for ?Endometrial Polyp with an Ovarian Solid Tumor 69 Case 36: VH with BSO followed by Laparotomy for Ovarian Cyst (Failed “Trial Vaginal Route” because of Ovarian “CA”) 70 Case 37: VH with BSO and Right Broad Ligament Myomectomy for Right Broad Ligament Fibroid (BLF) 71 Case 38: VH with BSO for Twisted Left Ovarian Cyst 73 Section 4: Nullipara and Vaginal Hysterectomy Case 39: VH in Nullipara with Intact Hymen 77 Case 40: VH with Uterine Debulking 79 Case 41: VH with Uterine Debulking Plus Right Ovarian Endometrial Cystectomy (H/O Myomectomy) 80 Case 42: VH with BSO for Bilateral Large Hydrosalpinx 81 Case 43: VH Plus Vaginal Cuff with BSO in Obese, Diabetic with Endometrial Cancer 82 Case 44: VH with BSO for Twisted Left Ovarian Cyst 83 Section 5: Vaginal Hysterectomy for Endometrial Cancer Introduction 87 Case 45: VH Plus Vaginal Cuff with BSO: Postmenopausal Bleeder with Endometrial Complex Hyperplasia with Atypia 91 Case 46: VH Plus Vaginal Cuff with BSO: Postmenopausal Bleeder with Corpus Cancer Syndrome for Endometrial Cancer (CA) 93 Case 47: VH Plus Vaginal Cuff with BSO for Endometrial CA 95 Case 48: VH Plus Vaginal Cuff with BSO: Postmenopausal Bleeder with Corpus Cancer Syndrome. Failed “Trial Vaginal Route”. Abdominal Surgery for LNR for Endometrial CA 96 Case 49: VH Plus Vaginal Cuff with BSO for Endometrial Complex Hyperplasia with Atypia. Corpus CA Syndrome Plus a History of Cardiac Bypass 98 Case 50: VH Plus Vaginal Cuff with BSO for Well-differentiated Endometrial Adenocarcinoma 99 Case 51: VH Plus Vaginal Cuff with BSO: Postmenopausal Bleeder with Endometrial CA with History of Two Caesarean Sections Followed by Incisional Hernia Repair 100 Case 52: VH Plus Vaginal Cuff with BSO Plus Laparoscopic Cholecystectomy for Postmenopausal Bleeder with Multiple Gallstones 101 Case 53: Laparoscopic Cholecystectomy and VH Plus Vaginal Cuff with BSO: “Failed Trial Vaginal Route Case” Abdominal LNR for Endometrial CA 102 Section 6: Failed Trial Vaginal Hysterectomy/Trial Vaginal Route Case 54: Undiagnosed Uteroabdominal Band 107 Case 55: Uterocervical Adhesions with Abdominal Wall 108 Case 56: Diminished “Uterus-free” Space (Altered Uterocervical Angle) 110 Case 57: Ovarian Endometriosis with Positive “Dimple Sign” 111 Case 58: Large-sized Uterus 112 Case 59: Ovarian Malignancy 113 Prelims.indd 14 10-04-2017 16:55:29 Contents xv Case 60: Uterine Bulk Impedes Descent 115 Case 61: Extensive Adhesions from PID (Pelvic Inflammatory Disease) Limits Descent for VH 116 Case 62: Unanticipated Uterine Adhesions to Abdominal Wall-1 117 Case 63: Unanticipated Uterine Adhesions to Abdominal Wall-2 118 Case 64: Unanticipated Uterine Adhesions to Abdominal Wall-3 119 Case 65: Parasitic Myoma and Inaccessible Adnexa Leads to Laparoscopic Completion of VH 120 Section 7: Special Cases: Vaginal Hysterectomy Case 66: VH Plus H/O Rupture Uterus and Two Caesarean Sections 123 Case 67: VH Plus Broad Ligament Myomectomy without Laparoscopy Plus Contralateral Endometriotic Cyst 125 Case 68: VH for CIN III 126 Case 69: VH for Metastatic Breast Cancer Plus Uterine Adenomyosis 127 Case 70: VH: Prophylactic for Hydatidiform Mole 128 Case 71: VH with BSO for Twisted Ovarian Cyst 129 Case 72: VH for Uterine Fibroids with H/O Failed Abdominal Hysterectomy 130 Case 73: VH under Local Anesthesia for Pulmonary Fibrosis 132 Case 74: VH with Altered Approach to VUP (VH with BSO) 134 Case 75: VH with Bicornuate Uterus 135 Case 76: Bladder Stone Removal at VH Plus Anterior and Posterior Repair 136 Case 77: Vaginal Hysterectomy as Emergency Procedure for Cornual Ectopic Pregnancy 138 Case 78: Vaginal Supracervical Hysterectomy 10 Years after Mesh Hysteropexy 139 Case 79: Vaginal Hysterectomy (VH): Incarcerated Prolapse due to Cervical Leiomyoma and an Intramural Myoma 140 Case 80: VH in Nullipara with Ongoing Chemotherapy for Non-gynecologic Malignancies 141 Case 81: VH for Endometrial Carcinoma in Morbidly Obese with History of Caesarean Section 142 Index 143 Prelims.indd 15 10-04-2017 16:55:30