Transvaginal hysterectomy: rationale and surgical approach.
Obstet Gynecol
; 103(6): 1321-5, 2004 Jun.
Article
em En
| MEDLINE
| ID: mdl-15172872
ABSTRACT
Abdominal hysterectomy is performed in the United States at a 31 ratio over vaginal hysterectomy, despite evidence that vaginal hysterectomy offers advantages over abdominal hysterectomy with regard to operative time, complication rates, recovery, return to daily activities, and overall costs of treatment. In fact, the predominance of the abdominal approach may be based on factors other than clinical considerations, including resident training, use of limited or obsolete guidelines, greater third-party compensation for abdominal procedures, a presumption rather than a confirmation that pathology exists that contraindicates a vaginal approach, and misconceptions about the safety and cost of vaginal hysterectomy. A number of studies spanning several years demonstrate that the use of more systematic guidelines for selecting the route of hysterectomy results in a major shift toward the vaginal approach. Evidence also shows that transvaginal hysterectomy is both feasible and optimum for types of patients who have long been considered inappropriate candidates for the vaginal route. New instrumentation facilitates the vaginal approach and contributes to improved hemostasis and decreased operative time. Included here is a step-by-step approach to determining appropriate candidates for the vaginal approach via assessment of access, uterus size, and extent of pathology.
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Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Histerectomia Vaginal
Tipo de estudo:
Guideline
Limite:
Female
/
Humans
Idioma:
En
Revista:
Obstet Gynecol
Ano de publicação:
2004
Tipo de documento:
Article