Surgical Techniques with Vaginal Approach

Definition and Indications

Vaginal hysterectomy is the surgical removal of the uterus through the vagina, without creating an external incision in the abdominal cavity. This technique is indicated in women with uterine conditions such as fibroids, endometriosis, benign cystic formations, endometrial hyperplasia, cervical diseases, and prolapse.

The choice of vaginal hysterectomy depends on various factors, including uterine size, history of previous surgeries, uterine mobility, and the experience of the urogynecologist surgeon.

Surgical Technique

The specialized urogynecologist surgeon performs the procedure with special surgical instruments inserted through the vagina. During the procedure, the urogynecologist surgeon must identify and protect important anatomical structures such as the ureters, bladder, and rectum.

Advantages of Vaginal Hysterectomy

Vaginal hysterectomy presents numerous advantages compared to abdominal approach. The absence of external incision leads to better aesthetic appearance, reduced postoperative pain, and faster return to daily activities.

Additionally, the duration of hospitalization is shorter and the risk of postoperative complications is significantly reduced.

From an economic perspective, vaginal hysterectomy proves more cost-effective due to reduced hospital stay and fewer postoperative complications. This makes the method particularly attractive for both patients and healthcare providers.

Theoretical Background

Vaginal cervicectomy refers to the surgical removal of the cervix through vaginal approach. This technique has been developed as an alternative solution for women who wish to preserve the uterus but need cervix removal due to precancerous lesions or other pathological conditions.

Cervicectomy is indicated primarily in cases of high-grade precancerous lesions (CIN III), recurrent dysplasias after surgical treatment, and in selected cases of early cervical cancer where fertility preservation is desired.

Surgical Methodology

Vaginal cervicectomy requires particular precision and experience from the surgeon. The procedure begins with careful assessment of the area's anatomy and determination of excision boundaries. Preservation of vascular structures that supply the uterus is critical for the procedure's success.

During the surgical procedure, the surgeon uses specialized instruments for precise tissue dissection and avoidance of damage to neighboring organs. Construction of a new internal uterine os is a critical step that affects future reproductive function.

Indications and Evaluation

Vaginal myomectomy is the selective removal of uterine fibroids through vaginal approach, while maintaining the organ's anatomical integrity. This technique is indicated in young women who wish to preserve fertility and present symptoms related to fibroids.

Selection of appropriate patients for vaginal myomectomy requires careful evaluation of the position, size, and number of fibroids. Generally, the method is more suitable for fibroids located in the lower part of the uterus and easily accessible through the vagina.

Surgical Strategy

Vaginal myomectomy requires particular surgical dexterity as the surgeon must perform the procedure in limited space while maintaining myometrial integrity. Preoperative use of pharmaceutical agents to shrink fibroids can facilitate the surgical procedure.

During the procedure, the surgeon locates the fibroids and proceeds with careful separation from the normal myometrium.

After the removal of the fibroids, restoration of the uterine anatomical structure is a critical step for maintaining the reproductive function. The use of appropriate materials and suturing techniques ensures proper healing and prevention of future complications.

Perioperative Complications

Surgical techniques with vaginal approach, although considered safe, are not free from potential complications. The most common perioperative complications include hemorrhage, injury to neighboring organs such as the bladder and ureters, and wound infections.

Prevention of these complications is based on thorough preoperative evaluation, use of appropriate surgical technique, and application of strict antisepsis rules. The experience of the urogynecologist surgeon plays a crucial role in avoiding complications.

Laparoscopic Surgery

Laparoscopic surgery is an alternative to vaginal techniques, especially in cases where vaginal approach is not feasible due to anatomical limitations.

Robotic Surgery

Robotic surgery is also an alternative to vaginal techniques in cases where vaginal approach is not feasible. It represents the most modern evolution in minimalist gynecological surgery.

Surgical techniques with vaginal approach continue to be the gold standard for many gynecological conditions. The continuous evolution of surgical instruments and the experience of the urogynecologist contribute to the procedure's success and avoidance of complications, with less recovery time.

Kostis Nikolopoulos applies modern techniques with respect for functionality and safety.

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