Vaginal Hysterectomy
SHIRISH S SHETHSynopsis
A Gynecologist is frequently recognized in terms of his or her level of expertise in a particular type of hysterectomy—the one using a laparoscope is considered the most up-to-date and those performing it robotically are believed to have better surgical skills than others; in reality, this is far from true in most of the cases. As for patients, vaginal hysterectomy is by far the best, as scientifically it is the hysterectomy of choice in the best interests of women, from among all four available routes and techniques or combinations thereof. A procedure that is ideal in one situation and suited to a particular gynecologist may not be so to another in a similar or different situation. What needs to be considered is not the situation or the surgeon’s efficiency but the method that is ideal for a suffering woman. Commonly, hysterectomies are compared in situations where the clinical findings are clearly not comparable; the results of such comparisons can, therefore, misguide decision-making for doctors and patients. <br/><br/>Laparoscopic surgery is boon and a great addition to our armamentarium as it has demonstrated the superiority of the vaginal over the abdominal route beyond an iota of doubt. This has led to a reduction in the incidence of the latter and promotion of the former. In the developed as well as the developing world, more and more workshops advocating vaginal hysterectomy is a classic example of this home truth. It must be appreciated, however, that laparoscopically assisted vaginal hysterectomy (LAVH) can replace an abdominal but not a vaginal hysterectomy. In reality, vaginal surgery is the least invasive route because one is using the entrance designed by nature, i.e. the natural orifice, without making any additional cuts—and is kinder to the patient. Vaginal hysterectomy differentiates the gynecological surgeon from some of the self-anointed gynecologists—laparoscopic surgeons, general surgeons and others—who can easily remove the uterus through the abdomen with equal competence. If vaginal surgery was marketed to patients as “scarless surgery”, perhaps, it would become more popular in a consumer-driven society. Addition of robotic surgery to hysterectomy, has added a new facet, fascination and advanced technology to compare, evaluate and crystallize its place in an ever-evolving medical world.
Synopsis
A Gynecologist is frequently recognized in terms of his or her level of expertise in a particular type of hysterectomy—the one using a laparoscope is considered the most up-to-date and those performing it robotically are believed to have better surgical skills than others; in reality, this is far from true in most of the cases. As for patients, vaginal hysterectomy is by far the best, as scientifically it is the hysterectomy of choice in the best interests of women, from among all four available routes and techniques or combinations thereof. A procedure that is ideal in one situation and suited to a particular gynecologist may not be so to another in a similar or different situation. What needs to be considered is not the situation or the surgeon’s efficiency but the method that is ideal for a suffering woman. Commonly, hysterectomies are compared in situations where the clinical findings are clearly not comparable; the results of such comparisons can, therefore, misguide decision-making for doctors and patients. <br/><br/>Laparoscopic surgery is boon and a great addition to our armamentarium as it has demonstrated the superiority of the vaginal over the abdominal route beyond an iota of doubt. This has led to a reduction in the incidence of the latter and promotion of the former. In the developed as well as the developing world, more and more workshops advocating vaginal hysterectomy is a classic example of this home truth. It must be appreciated, however, that laparoscopically assisted vaginal hysterectomy (LAVH) can replace an abdominal but not a vaginal hysterectomy. In reality, vaginal surgery is the least invasive route because one is using the entrance designed by nature, i.e. the natural orifice, without making any additional cuts—and is kinder to the patient. Vaginal hysterectomy differentiates the gynecological surgeon from some of the self-anointed gynecologists—laparoscopic surgeons, general surgeons and others—who can easily remove the uterus through the abdomen with equal competence. If vaginal surgery was marketed to patients as “scarless surgery”, perhaps, it would become more popular in a consumer-driven society. Addition of robotic surgery to hysterectomy, has added a new facet, fascination and advanced technology to compare, evaluate and crystallize its place in an ever-evolving medical world.
Description
A Gynecologist is frequently recognized in terms of his or her level of expertise in a particular type of hysterectomy—the one using a laparoscope is considered the most up-to-date and those performing it robotically are believed to have better surgical skills than others; in reality, this is far from true in most of the cases. As for patients, vaginal hysterectomy is by far the best, as scientifically it is the hysterectomy of choice in the best interests of women, from among all four available routes and techniques or combinations thereof. A procedure that is ideal in one situation and suited to a particular gynecologist may not be so to another in a similar or different situation. What needs to be considered is not the situation or the surgeon’s efficiency but the method that is ideal for a suffering woman. Commonly, hysterectomies are compared in situations where the clinical findings are clearly not comparable; the results of such comparisons can, therefore, misguide decision-making for doctors and patients. <br/><br/>Laparoscopic surgery is boon and a great addition to our armamentarium as it has demonstrated the superiority of the vaginal over the abdominal route beyond an iota of doubt. This has led to a reduction in the incidence of the latter and promotion of the former. In the developed as well as the developing world, more and more workshops advocating vaginal hysterectomy is a classic example of this home truth. It must be appreciated, however, that laparoscopically assisted vaginal hysterectomy (LAVH) can replace an abdominal but not a vaginal hysterectomy. In reality, vaginal surgery is the least invasive route because one is using the entrance designed by nature, i.e. the natural orifice, without making any additional cuts—and is kinder to the patient. Vaginal hysterectomy differentiates the gynecological surgeon from some of the self-anointed gynecologists—laparoscopic surgeons, general surgeons and others—who can easily remove the uterus through the abdomen with equal competence. If vaginal surgery was marketed to patients as “scarless surgery”, perhaps, it would become more popular in a consumer-driven society. Addition of robotic surgery to hysterectomy, has added a new facet, fascination and advanced technology to compare, evaluate and crystallize its place in an ever-evolving medical world.
Key Features
In recent years, advances in technologies, laparoscopic and robotic, have led to renewed interest in the approach per vias naturales to hysterectomy, which has many proven benefits for patients. This volume, dedicated to explaining and promoting the vaginal route of hysterectomy, is written and edited by experienced and dedicated Gynecologist and provides a much-needed source of up-do-date information and guidance.
Importantly, the author cautions that laparoscopic technology can provide a valuable source of assistance for the gynecological surgeon in certain circumstances, though only in 'select' cases. This book, beautifully illustrated with line drawings and full-color photographs, contains step-by-step surgical techniques, enabling the surgeon to gain confidence and experience so that gradually more challenging operations can be managed successfully via the vaginal route or natural orifice. Acknowledged select authorities from India and around the world take the readers through several clinical situations for the vaginal approach, including endometrial cancer and offer an evidence-based elucidation of the 'why; 'when' and 'how' of vaginal hysterectomy.
Specific topics considered here include: Crucial preoperative assessment, the nulliparous patient, uterine fibroids, debulking, prophylactic salpingo-oophorectomy, adnexectomy for adnexal pathology, prolapse repair with or without bolsters, the place of sacrospinous colpopexy, urethral sphincter incompetence, and the hysterectomy and sexuality. Howard Jones brings finale with choice of hysterectomy. The book gives full review of the potential complications, morbidity and mortality associated with the vaginal approach. Contributions from noted expert colleagues beyond India DeCherney, Jones, Kovac, Magos, Magrina, Pelosi, Rane and Zimmerman provide to this book and the readers with unbias, well balanced with zero conflict of or vested interest crystallized material through appraisal of hysterectomy via vaginal route. In addition, the author set forth the arguments for and against vaginal hysterectomy, abdominal hysterectomy, laparoscopic assistance, and transcervical resection of the endometrium.
Product Details
Publisher :
JPB ;2/e edition (01 January 2014)
Edition :
2/e edition
Binding :
Hard Back
Language :
English
Paperback :
374 pages
ISBN-13 :
9789351521792
Dimensions :
8.5 x 11
Printing Format Color :
Four Color