- Thomas G Stovall, MD
Thomas G Stovall, MD
- Professor of Obstetrics and Gynecology
- University of Tennessee
- William J Mann, Jr, MD
William J Mann, Jr, MD
- Section Editor — Gynecologic Surgery
- Clinical Professor
- Department of Obstetrics and Gynecology
- Virginia Commonwealth University School of Medicine
Hysterectomy (surgical removal of the uterus) may be performed via an abdominal, vaginal, or laparoscopically-assisted vaginal approach. Once the decision has been made to proceed with hysterectomy, the physician must decide upon the route, which depends upon clinical circumstances and the surgeon's technical expertise. (See "Choosing a route of hysterectomy for benign disease".)
INDICATIONS AND CONTRAINDICATIONS
The indications for and alternatives to hysterectomy are discussed elsewhere. (See "Choosing a route of hysterectomy for benign disease".)
Regarding contraindications, in general, gynecologic malignancies should not be approached by a vaginal approach, and prior pelvic radiation is also a relative contraindication.
The reason for the hysterectomy, risks and benefits of the procedure, alternatives, and expectations for outcome, should be discussed with the woman in detail. Few procedures for benign disease engender as much patient anxiety and concern as hysterectomy. There are a number of indications for hysterectomy that are based more upon opinion than evidence from well-designed studies. In these situations, informed consent with thorough exploration of patient preferences and expectations is most important.
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- Cruikshank SH, Kovac SR. Randomized comparison of three surgical methods used at the time of vaginal hysterectomy to prevent posterior enterocele. Am J Obstet Gynecol 1999; 180:859.
- Harmanli OH, Khilnani R, Dandolu V, Chatwani AJ. Narrow pubic arch and increased risk of failure for vaginal hysterectomy. Obstet Gynecol 2004; 104:697.
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- INDICATIONS AND CONTRAINDICATIONS
- PREOPERATIVE PREPARATION
- OPERATIVE PROCEDURE
- Initial steps
- - Entry
- - Ligating the uterine vessels
- Ancillary procedures for complicated cases
- - Uterine morcellation
- - Poor uterine descensus
- - Laparoscopic assistance
- Doderlein procedure
- POSTOPERATIVE CARE AND DISCHARGE INSTRUCTIONS
- Urologic issues
- - Urinary incontinence
- - Ureteral injury
- - Bladder injury
- Bowel injury
- - Small bowel injury
- - Colonic injury
- Urinary retention
- Fallopian tube prolapse
- Vaginal cuff evisceration
- Earlier menopause
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS