Difficult vaginal hysterectomy

Foreword

Hysterectomy is the most frequent gynecological surgery performed everywhere. The idea to extract the uterus by vaginal route is lost in antiquity. The history of modem hysterectomy dates back over 200 years.

Vaginal hysterectomy dominated for a long time the gynecological surgery for benign and malignant diseases of the uterus. Vaginal hysterectomy was dethroned by abdominal hysterectomy with the introduction of modem anesthesia, asepsis and antisepsis, and antibiotics. ,,At the beginning of 80, after 30 years of vaginal hysterectomy revived. For a short period, it's back in the news. Unfortunately, the surgical progress marked by the introduction of laparoscopic hysterectomy in 1989 by Harry Reich triggered a new wave that tends to cover the vaginal hysterectomy again.

Vaginal surgery was the only surgical branch where the gynecologist could enhance his surgical abilities until laparoscopic surgery appeared. Although a difficult surgery performed through a natural orifice, vaginal surgery brings an undeniable advantage for patients. This minimally invasive nature confers a good postoperative evolution, low complications, and quick recovery. Vaginal hysterectomy is the cheapest alternative for uterus ablation who does not need anything but proper instrumentation and a trained surgeon.

Currently, most vaginal interventions used in clinical practice are reconstructive and mainly refer to pelvic floor disorders, the ablative surgery of the uterus, and adenexes being reserved for the open or laparoscopic abdominal route in the vast majority of cases.

From the first vaginal ·hysterectomy and to date, many technical variants have been described that were intended to give the patient safety and give the surgeon a logical sequence of operative steps. Unfortunately, the surgery is not an exact science, and the variability of human pathology often puts the surgeon in the face of situations that make each case a special one.

This book aims to provide solutions for most situations where vaginal hysterectomy can become difficult. It is a book derived from an experience of over 4500 cases of vaginal hysterectomies for unprolapsed uterus, which we dedicate to all gynecologists who want to carry on the tradition of vaginal surgery.

Authors

Table of contents

Foreword

Chapter 1: Vaginal hysterectomy past, present and future 1

Chapter 2: Surgical anatomy 10

Chapter 3: Preoperative evaluation and preparation prior vaginal hysterectomy 22

Chapter 4: Total vaginal hysterectomy for unprolapsed uterus (basic technique) 34

Chapter 5: Reduced uterine accesibility and mobility 52

Chapter 6: Difficult cleavage spaces 63

Chapter 7: Difficulties in uterine release in vaginal hysterectomy 7 6

Chapter 8: Difficult vaginal adnexectomy 89

Chapter 9: Laparoscopically assisted vaginal hysterectomy 96

Chapter 10: Complications in vaginal hysterectomy 108

Chapter 11: Lesions of neighbouring organs during vaginal hysterectomy 123

 "Difficult Vaginal Hysterectomy" is a comprehensive textbook that serves as a valuable resource for gynecologic surgeons, and residents seeking to enhance their skills in performing difficult vaginal hysterectomies. This authoritative guide presents a wealth of knowledge and expertise, empowering practitioners to overcome complex surgical scenarios and achieve successful outcomes. Written by two distinguished experts in the field, this textbook delves into the intricacies of challenging vaginal hysterectomy procedures, providing in-depth explanations, practical strategies to overcome various difficulties encountered during surgery and all the relevant references. It bridges the gap between theory and practice, offering a step-by-step approach to help surgeons navigate complex anatomical variations, challenging pathologies, and intraoperative complications. " Difficult Vaginal Hysterectomy " is an indispensable textbook for practitioners seeking to expand their proficiency in performing difficult vaginal hysterectomies. By combining theoretical knowledge with practical insights, this authoritative resource empowers gynecologic surgeons to overcome complex surgical scenarios and deliver optimal patient care.     

Burghard Abendstein PhD