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

Section 1: VAGINAL HYSTERECTOMY (VH) WITH UTERINE DEBULKING

• Case 1: VH WITH UTERINE DEBULKING
• Case 2: VH WITH UTERINE DEBULKING PLUS BILATERAL SALPINGO-OOPHORECTOMY (BSO) (CA125: 516)
• Case 3: VH WITH UTERINE DEBULKING PLUS OVARIAN CYSTECTOMY
• Case 4: VH WITH MASSIVE UTERINE DEBULKING PLUS BILATERAL SALPINGO-OOPHORECTOMY (RIGHT HYDROSALPINX)
• Case 5: VH WITH DEBULKING PLUS BILATERAL SALPINGO-OOPHORECTOMY FOR LEFT OVARIAN ENDOMETRIAL CYST AND RIGHT OVARIAN TERATOMA WITH H/O 2 C SECTIONS
• Case 6: VH WITH UTERINE DEBULKING PLUS BILATERAL SALPINGO-OOPHORECTOMY AND LAPAROSCOIC CHOLECYSTECTOMY
• Case 7: VH PLUS BILATERAL SALPINGECTOMY, RIGHT OOPHERECTOMY
• Case 8: VH PLUS BILATERAL SALPINGECTOMY
• Case 9: VH PLUS BILATERAL SALPINGECTOMY
• Case 10: VH PLUS RIGHT SALPINGECTOMY
• Case 11: VH PLUS BILATERAL SALPINGECTOMY
• Case 12: VH PLUS BILATERAL SALPINGECTOMY
• Case 13: VH PLUS BILATERAL SALPINGECTOMY
• Case 14: VH + BILATERAL SALPINGECTOMY

Section 2A: VAGINAL HYSTERECTOMY (VH) WITH H/O CAESAREAN SECTION(S)

• Case 15: VH PLUS LEFT OVARIAN CYSTECTOMY
• Case 16: VH PLUS STRESS URINARY INCONTINENCE (SUI) REPAIR
• Case 17: VH PLUS UTERINE DEBULKING
• Case 18: VH PLUS RIGHT OVARIAN CYSTECTOMY: ENDOMETRIAL HYPERPLASIA
• Case 19: VH PLUS LEFT SALPINGO-OOPHORECTOMY FOR OVARIAN ENDOMETRIAL CYST IN A MORBIDLY OBESE PATIENT
• Case 20: VH PLUS BILATERAL SALPINGO-OOPHORECTOMY FOR BILATERAL OVARIAN ENDOMETRIOTIC CYSTS WITH POSITIVE ‘DIMPLE SIGN’
• Case 21: VH PLUS BILATERAL SALPINGO-OOPHORECTOMY FOR ABNORMAL UTERINE BLEEDING WITH H/O C. SECTIONS AND RUPTURE UTERUS
• Case 22: VH PLUS VAGINAL CUFF WITH BILATERAL SALPINGO-OOPHORECTOMY FOR POST- MENOPAUSAL BLEEDER IN A MORBIDLY OBESE AND DIABETIC PATIENT
• Case 23: VH PLUS ALTERED APPROACH TO VESICO-UTERINE PERITONEUM
• Case 24: VH IN NULLIPARA WITH H/O ABDOMINAL MYOMECTOMY
  Case 25: VH PLUS SALPINGECTOMY IN PRIMIPARA WITH H/O ABDOMINAL MYOMECTOMY AND RECURRENT LARGE FIBROIDS
• Case 26: VH IN HEAVY CIGARETTE SMOKER WITH H/O 2 CLASSICAL CAESAREAN SECTIONS VIA MIDLINE VERTICAL LAPAROTOMY
• Case 27: VH WITH UTERINE DEBULKING PLUS BILATERAL SALPINGECTOMY OF TUBAL REMNANTS AFTER 4 CAESAREAN SECTIONS AND NO VAGINAL BIRTHS

Section 2B: VAGINAL HYSTERECTOMY (VH) WITH HISTORY OF (H/O) UTERINE SURGERY IN PAST

• Case 28: VH PLUS BILATERAL SALPINGECTOMY AFTER 1 CESAREAN AND NO VAGINAL BIRTHS
• Case 29: VH WITH UTERINE DEBULKING AFTER 6 MIDLINE VERTICAL LAPAROTOMIES (5 CAESAREAN SECTIONS AND 1 ECTOPIC PREGNANCY) IN A MORBIDLY OBESE CIGARETTE SMOKER

Section 3: VAGINAL HYSTERECTOMY (VH) WITH ADNEXAL PATHOLOGY

• Case 30: VH WITH BILATERAL SALPINGO-OOPHORECTOMY FOR LARGE BILATERAL HYDROSALPINX.
• Case 31: VH WITH LEFT SALPINGO-OOPHORECTOMY FOR OVARIAN ENDOMETRIAL CYST IN MORBIDLY OBESE WITH PAST H/O 2 C. SECTIONS
• Case 32: VH WITH BILATERAL SALPINGO-OOPHORECTOMY FOR LEFT OVARIAN ENDOMETRIAL CYST AND RIGHT OVARIAN TERATOMA WITH H/O. 2 C SECTIONS
• Case 33: VH WITH BILATERAL SALPINGO-OOPHORECTOMY FOR BILATERAL OVARIAN ENDOMETRIAL CYSTS WITH POSITIVE ‘DIMPLE SIGN’
• Case 34: VH WITH BILATERAL SALPINGO-OOPHORECTOMY FOR A SOLID OVARIAN TUMOR
• Case 35: VH WITH BILATERAL SALPINGO-OOPHORECTOMY FOR A ENDOMETRIAL HYPERPLASIA WITH AN OVARIAN SOLID TUMOR.
• Case 36: VH WITH BILATERAL SALPINGO-OOPHORECTOMY FOLLOWED BY LAPAROTOMY FOR OVARIAN CYST (FAILED ‘TRIAL VAGINAL ROUTE’ BECAUSE OF OVARIAN ‘CA’)
• Case 37: VH WITH BILATERAL SALPINGO-OOPHORECTOMY FOR RIGHT OVARIAN ENDOMETRIAL CYST AND LEFT BROAD LIGAMENT MYOMECTOMY FOR LEFT BROAD LIGAMENT FIBROID
• Case 38: VH WITH BILATERAL SALPINGO-OOPHORECTOMY FOR TWISTED LEFT OVARIAN CYST

Section 4: NULLIPARA AND VAGINAL HYSTERECTOMY (VH)

• Case 39: VH IN NULLIPARA WITH INTACT HYMEN
• Case 40: VH WITH UTERINE DEBULKING
  Case 41: VH WITH UTERINE DEBULKING PLUS RIGHT OVARIAN ENDOMETRIAL CYSTECTOMY (H/O MYOMECTOMY)
• Case 42: VH WITH BILATERAL SALPINGO-OOPHORECTOMY FOR BILATERAL LARGE HYDROSALPINX
• Case 43: VH PLUS VAGINAL CUFF WITH BILATERAL SALPINGO-OOPHORECTOMY IN OBESE, DIABETIC WITH ENDOMETRIAL CANCER
• Case 44: VH WITH BILATERAL SALPINGO-OOPHORECTOMY FOR TWISTED LEFT OVARIAN CYST

Section 5: VAGINAL HYSTERECTOMY (VH) FOR ENDOMETRIAL CANCER

• Case 45: VH PLUS VAGINAL CUFF WITH BILATERAL SALPINGO-OOPHORECTOMY. POST- MENOPAUSAL BLEEDER WITH ENDOMETRIAL COMPLEX HYPERPLASIA WITH ATYPIA
• Case 46: VH PLUS VAGINAL CUFF WITH BILATERAL SALPINGO-OOPHORECTOMY. POST- MENOPAUSAL BLEEDER WITH CORPUS CANCER SYNDROME FOR ENDOMETRIAL CANCER
• Case 47: VH PLUS VAGINAL CUFF WITH BILATERAL SALPINGO-OOPHORECTOMY FOR ENDOMETRIAL CANCER
• Case 48: VH PLUS VAGINAL CUFF WITH BILATERAL SALPINGO-OOPHORECTOMY. POST- MENOPAUSAL BLEEDER WITH CORPUS CANCER SYNDROM. FAILED ‘TRIAL VAGINAL ROUTE’. ABDOMINAL SURGERY FOR LYMPH NODE REMOVAL FOR ENDOMETRIAL CANCER
• Case 49: VH PLUS VAGINAL CUFF WITH BILATERAL SALPINGO-OOPHORECTOMY FOR ENDOMETRIAL COMPLEX HYPERPLASIA WITH ATYPIA. CORPUS CANCER SYNDROME PLUS A PAST H/O CARDIAC BYPASS
• Case 50: VH PLUS VAGINAL CUFF WITH BILATERAL SALPINGO-OOPHORECTOMY FOR WELL DIFFERENTIATED ENDOMETRIAL ADENOCARCINOMA
• Case 51: VH PLUS VAGINAL CUFF WITH BILATERAL SALPINGO-OOPHORECTOMY. POST- MENOPAUSAL BLEEDER WITH ENDOMETRIAL CANCER WITH H/O 2 C SECTIONS FOLLOWED BY INCISIONAL HERNIA REPAIR
• Case 52: VH PLUS VAGINAL CUFF WITH BILATERAL SALPINGO-OOPHORECTOMY PLUS LAPAROSCOPIC CHOLECYSTECTOMY FOR POST-MENOPAUSAL BLEEDER WITH MULTIPLE GALL STONES
• Case 53: LAPAROSCOPIC CHOLECYSTECTOMY AND VH PLUS VAGINAL CUFF WITH BILATERAL SALPINGO-OOPHORECTOMY. ‘FAILED TRIAL VAGINAL ROUTE CASE’ ABDOMINAL LYMPH NODE REMOVAL FOR ENDOMETRIAL CANCER

Section 6: FAILED ‘TRIAL VAGINAL HYSTERECTOMY’ / ‘TRIAL VAGINAL ROUTE’

• Case 54: UNDIAGNOSED UTERO ABDOMINAL BAND
• Case 55: UTEROCERVICAL ADHESIONS WITH ABDOMINAL WALL
• Case 56: DIMINISHED ‘UTERUSFREE’ SPACE (ALTERED UTEROCERVICAL ANGLE)
• Case 57: OVARIAN ENDOMETRIOSIS WITH POSITIVE DIMPLE SIGN
• Case 58: LARGE SIZED UTERUS
• Case 59: OVARIAN MALIGNANCY
• Case 60: TOTAL ABDOMINAL HYSTERECTOMY (TAH) WITH BILATERAL SALPINGECTOMY
• Case 61: TAH WITH BILATERAL SALPINGECTOMY, EXTENSIVE ADHESIOLYSIS
• Case 62: TAH PLUS BILATERAL SALPINGECTOMY
• Case 63: TAH PLUS BILATERAL SALPINGECTOMY
• Case 64: TAH PLUS BILATERAL SALPINGECTOMY PLUS RIGHT OOPHERECTOMY
• Case 65: LAPAROSCOPIC COMPLETION OF HYSTERECTOMY PLUS BILATERAL SALPINGECTOMY

Section 7: SPECIAL CASES: VAGINAL HYSTERCTOMY (VH)

• Case 66: VH PLUS H/O RUPTURE UTERUS AND TWO C. SECTIONS
• Case 67: VH PLUS BROAD LIGAMENT MYOMECTOMY WITHOUT LAPAROSCOPY PLUS CONTRALATERAL ENDOMETRIOTIC CYST
• Case 68: VH PLUS CERVICAL INTRAEPITHELIAL NEOPLASIA (CIN) III
• Case 69: VH PLUS METASTATIC BREAST CANCER PLUS UTERINE ADENOMYOSIS
• Case 70: VH PLUS PROPHYLACTIC FOR HYDATIDIFORM MOLE
• Case 71: VH PLUS TWISTED OVARIAN CYST
• Case 72: VH PLUS UTERINE FIBROIDS WITH H/O FAILED ABDOMINAL HYSTERECTOMY
• Case 73: VH PLUS UNDER LOCAL ANESTHESIA
• Case 74: VH PLUS ALTERED APPROACH TO VESICO-UTERINE PERITONEUM (VH WITH BILATERAL SALPINGO-OOPHORECTOMY)
• Case 75: VH PLUS BICORNUATE UTERUS
• Case 76: BLADDER STONE REMOVAL AT VH PLUS ANTERIOR AND POSTERIOR REPAIR
• Case 77: VAGINAL HYSTERECTOMY (VH): INCARCERATED PROLAPSE DUE TO CERVICAL LEIOMYOMA AND A INTRAMURAL MYOMA
• Case 78: VH IN NULLIPARA WITH ONGOING CHEMOTHERAPY FOR NON-GYNECOLOGIC MALIGNANCIES.
• Case 79: VH FOR ENDOMETRIAL CARCINOMA IN MORBIDLY OBESE WITH HISTORY OF C SECTION
• Case 80: EMERGENCY VH + BILATERAL SALPINGECTOMY AND UTEROSACRAL SUSPENSION
• Case 81: VAGINAL SUPRACERVICAL HYSTERECTOMY 10 YEARS AFTER MESH HYSTEROPEXY IN PAST

Shirish S Sheth MD FRCOG FACOG FACS FICS FCPS FICOG FAMS FSOGC
Consultant Gynaecologist, Breach Candy Hospital and Saifee Hospital, Mumbai, Maharashtra, India

Carl W Zimmerman MD
Division Director Female Pelvic Medicine and Reconstructive Surgery, Frances and John C Burch Chair in Obstetrics and Gynaecology, Vanderbilt University School of Medicine, Nashville, TN, USA

Seth Finkelstein MD
Consultant Obstetrician and Gynaecologist, Lenox Hill Hospital, New York; Kingsbrook Jewish Medical Centre, Brooklyn, NY, USA