c l i n i c a l f o l i o s : n a r r a t i v e





A D V E R T I S E M E N T

 

Transabdominal Hysterectomy: 19

A D V E R T I S E M E N T

   
 

The distal vaginal cuff is shown.       

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Transabdominal Hysterectomy: 20

A D V E R T I S E M E N T

   
 

The vaginal cuff was closed with locking 0 chromic sutures, incorporating the ligated uterosacral and cardinal ligament stumps in the corners of the closure. The pelvic peritoneum was closed.       

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Transabdominal Hysterectomy: 21

A D V E R T I S E M E N T

   
 

The specimen is shown.

Gynecologic Surgeon: Jason Heaton
Gynecological Resident: Kristina Vogel

Discussion: 

Hysterectomy is the most common surgical procedure performed on women, and the most common indications in order are fibroids, abnormal uterine bleeding, endometriosis and prolapse (together accounting for 69% of cases). Ten percent are done for cancer and another 5% for endometrial hyperplasia. The remainder are done for persistent cervical dysplasia, adenomysosis, infectious and obstetrical complications. Hysterectomy can be performed transabdominally and vaginally (with or without laparoscopic assistance). Uterine size and pathology help dictate the choice of procedure.

Vaginal hysterectomy, while less morbid than the abdominal route, may be limited by the size of the uterus, the need for oophorectomy, or pathology requiring examination of the upper abdomen beyond the capability of laparoscopy. Abdominal hysterectomy, with or without salpingo-oophorectomy, can be done through a midline or transverse (Pfannensteil) incision (skin incision above pubic hairline, lower vertical midline fascial incision). Laparoscopic assisted vaginal hysterectomy is reducing the number of abdominal hysterectomies performed. Medical treatment also offers a comparable degree of relief of pain from fibroids for many patients, but about 25% of patients so treated ultimately come to hysterectomy.

References:

 Wheeless Jr. CR, Atlas of Pelvic Surgery, 2nd ed, Lea & Febiger, 1988:251-255.

Ryan: Kistner's Gynecology & Women's Health, Seventh Edition, Copyright 1999 Mosby, Inc. :137-139.

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This page was last modified on 1/5/2001.