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Vaginal hysterectomy

INTRODUCTION

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 "Overview of hysterectomy".)

Issues related to vaginal hysterectomy will be reviewed here. Other hysterectomy procedures are discussed separately. (See "Abdominal hysterectomy" and "Laparoscopic approach to hysterectomy".)

INDICATIONS AND ALTERNATIVES

The indications for and alternatives to hysterectomy are discussed elsewhere. (See "Overview of hysterectomy".)

PREOPERATIVE PREPARATION

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.

Education during the preoperative visit is one of the most important means of ensuring the patient's acceptance and compliance during the immediate postoperative period. Women are provided with positive statements about what to expect postoperatively and regarding return to normal activities along with a standard surgical informed consent. (See "Preoperative evaluation and preparation of women for gynecologic surgery".)
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