Vaginal Hysterectomy

The removal of the womb via the vagina. In most cases, this is the route of choice. Vaginal removal obviates the need for a skin incision significantly reducing post operative pain and immobility. I will offer this route in all cases where it is possible.

A spinal or general anaesthetic can be offered for this procedure. We use stirrups to gain vaginal access. The bladder is emptied and catheterised. The mouth of the womb, or cervix, is grasped and infiltrated with local anaesthetic. This helps to define the tissue layers, as well as improve pain control. A circular incision is made in the cervix. The bladder is moved from the upper surface and the rectum from the lower surface.

The membrane surrounding the abdominal cavity, or peritoneum, is punctured, exposing the connecting tissue, ligaments and blood vessels at the sides. These are then clamped and sutures in 3 or 4 steps at each side.The ovaries are inspected and biopsies may be taken. The fallopian tubes may also be removed. A vault repair is then performed using the remnants of the cardinal ligaments to ensure the vaginal vault remains secure and stable.

A corrugated drain and cloth vaginal plug are inserted which remain over night.A scope of the bladder (cystoscopy) may be conducted if you have had previous surgery (such as a C/section) Hospitalisation generally lasts 2 nights.

Dr Douglas Seton, Obestetrician & Gynaecologist Knysna © 2021

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