After cesarean section, hysterectomy is the most commonly performed major operation on women by obstetricians. The major cause of patients undergoing hysterectomy is not cancer (90%), it mostly comes from the problems like myoma uteri followed by endometriosis, prolapsed uterus, endometrial hyperplasia, endometrial polyps, cervical intraepithelial neoplasia and gynecological cancers.
Today there are four used techniques of hysterectomy
1. Vaginal hysterectomy
2. Laparoscopic hysterectomy
3. Minilaparotomy hysterectomy
4. Abdominal hysterectomy
Until now medical evidences have indicated that vaginal hysterectomy provides better outcome than laparoscopic hysterectomy in term of safety, beauty, recovery period, hospital stay and lower cost.
Compared to abdominal hysterectomy, laparoscopic hysterectomy produces more effective result; patients can recover faster, discharge earlier and less infection arising in surgical wound. However, it takes a long period of time to perform laparoscopic hysterectomy and complications such as ureteral injury and bladder injury are more likely to occur to patients than vaginal hysterectomy, the surgical procedure to remove a woman’s uterus through the vagina without leaving visible scar. Vaginal hysterectomy is thus considered as the innovation technique of hysterectomy in Thailand.
Vaginal hysterectomy was first performed by German doctor, Langenbeck, in 1813. Initially, this surgical technique is done on patients with prolapsed uterus only but later the surgery was developed to be able to remove uterus through the vagina even though no prolapsed uterus is found.
American congress of obstetrician and gynecologist ACOG published the opinion of its committee into the journal called Obstet & Gynecol, November issue, 2009, it is stated that when there are implications to remove the uterus and cancer is not present, vaginal hysterectomy should be first considered as it is the safe and least expensive procedure. Vaginal hysterectomy has less complications and the healing time is shorter than laparoscopic hysterectomy and abdominal hysterectomy.
The evolution in the technique of surgery and technological progress in surgical devices enables vaginal hysterectomy to perform in every case not only for prolapsed uterus. This includes myoma uteri, endometriosis, endometrial hyperplasia, cervical intraepithelial neoplasia, and abnormal uterine bleeding. Vaginal hysterectomy can be performed on patients who have never had sex, never been pregnant, and have undergone caesarean section before, the research points out that vaginal hysterectomy mostly can be performed on these 3 groups of patients. However, this depends on surgical skill, experience and expertise of obstetricians who perform the surgical procedure.
You may find our specialist here at Women Center, Phyathai 2 Hospital
Phyathai 2 Hospital