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Vaginal hysterectomy
Vaginal hysterectomy is the removal of the uterus through the vagina and is a minimally invasive surgery.
This technique is used in surgeries for enlarged uteruses with fibroids, initial stages of endometrial and cervical cancer, endometrial hyperplasia, heavy bleeding, but is also part of reconstructive surgery for genital organ prolapse.
The first described vaginal hysterectomy was performed in 1813 in Germany, while the first abdominal hysterectomy was performed in 1843 in England. The technique of vaginal hysterectomy was mainly developed later by French gynecologists.
Vaginal hysterectomy is today a well-established surgical method that is a combination of good surgical technique and modern technology.
Why is a vaginal hysterectomy a better choice?
The advantages of vaginal hysterectomy compared to other techniques are that:
- there is no incision on the stomach;
- shorter duration of surgery;
- faster recovery.
The Cochrane Data Base of Systematic Review, which analyzes methods and results in medicine, has shown that vaginal hysterectomy has an advantage over laparoscopic hysterectomy due to a shorter operation time, less risk of injury to the urinary organs and faster return to daily activities.
The first option for minimally invasive hysterectomy
The principle in surgery is that when an organ is removed, access to that organ should be through the smallest possible incision and minimal damage to the surrounding healthy tissue. This is achieved by separating the organ from the surrounding tissue by "ligating" the blood vessels that supply and drain blood to that organ. The organ is also separated from the connective tissue that surrounds it.
In vaginal hysterectomy, the uterus is accessed through the vagina and an incision in the anterior abdominal wall is avoided.
The uterus is gradually released from the surrounding tissue, starting from the lower part, that is, the cervix.
In abdominal (open) and laparoscopic hysterectomy, either an incision of 10 cm or more or several small incisions of 5-12 mm is made on the front abdominal wall and then the uterus is separated from the surrounding tissue "from the top", contrary to vaginal hysterectomy.
When a vaginal hysterectomy is performed, the fallopian tubes and ovaries can be removed vaginally.
A scar-free recovery and a quick return to normal life
- There are no incisions or scars on the anterior abdominal wall.
- The patient can drink and eat 3-4 hours after the surgery and is usually discharged from the hospital the day after the surgery.
- You can return to normal activities after 10-14 days, and to physical training after a month.
- Sexual intercourse is not recommended for 6 weeks after the surgery.
Case presentation
Vaginal hysterectomy is performed in the Clinic Milenković and is recommended as the method of choice when removing the uterus.
- A 45-year-old female patient with several large fibroids, the dimensions of the uterus are 17x15x10 cm. The upper level of the uterus is at the level of the navel.
- She gave birth to two children. She has heavy bleeding, a feeling of pressure in the small pelvis and frequent urination.
- She was treated with a hormonal spiral, but there was no effect.
- Vaginal hysterectomy was performed with removal of both fallopian tubes.
The patient was discharged from the hospital the day after surgery and returned to her office job 3 weeks after surgery.
- A 62-year-old female patient, obese, BMI 38, with postmenopausal bleeding.
- An endometrial biopsy was performed and endometrial cancer was diagnosed.
- Magnetic resonance imaging showed that the cancer covers less than 50% of the uterine wall.
- Vaginal hysterectomy was performed with removal of both ovaries and fallopian tubes.
The patient was discharged from the hospital after 2 days and returned to normal activities after two weeks.
- A 66-year-old female patient with uterine prolapse. During physical exertion, the uterus "comes out" from the vagina.
- She has three children. In addition to the unpleasant feeling, there is pain and pressure in the vagina and difficulty urinating.
- A vaginal hysterectomy was performed with the removal of both ovaries and fallopian tubes, and the vaginal tip was "secured" to the ligaments-connective tissue in the uterus.
- The reconstruction of the perineum, the tissue between the vagina and the anus, was also performed.
The patient feels well and has no symptoms one year after the surgery. The patient uses vaginal estrogen.
Potential complications
Complications during and after vaginal hysterectomy are very rare.
- Bladder and urinary tract injuries occur in 1.5-3% of cases, while bowel injuries are less than 1%.
- Bleeding during and after surgery occurs in 3-4% of women who have had their uterus removed vaginally.
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