Name of the Procedure:

Vaginal hysterectomy for uterus greater than 250 g

Summary

A vaginal hysterectomy is a surgical procedure where the uterus, weighing more than 250 grams, is removed through the vaginal canal. This procedure is typically less invasive than an abdominal hysterectomy and allows for a quicker recovery time.

Purpose

This procedure addresses medical conditions such as large uterine fibroids, severe endometriosis, chronic pelvic pain, heavy menstrual bleeding, or uterine prolapse. The goal is to alleviate symptoms, improve quality of life, and, in some cases, eliminate the risk of certain cancers.

Indications

• Large uterine fibroids
• Severe endometriosis
• Chronic pelvic pain not responsive to other treatments
• Heavy or prolonged menstrual bleeding
• Uterine prolapse
• Precancerous conditions or cancers of the uterus or cervix

Preparation

• Fasting for 8-12 hours before the procedure
• Temporary discontinuation of certain medications (e.g., blood thinners)
• Preoperative blood tests, imaging studies (e.g., ultrasound or MRI)
• Enema or laxative the day before surgery

Procedure Description

1. Anesthesia: General or regional anesthesia is administered.
2. Incisions: No external incisions are made, as the uterus is accessed through the vaginal canal.
3. Dissection: The surgeon makes small incisions in the vaginal wall to access the uterus.
4. Uterus Removal: The uterus is carefully dissected and removed piece by piece if necessary to ensure complete extraction.
5. Closure: The vaginal incisions are sutured closed, and absorbable stitches are typically used.

Tools and Equipment:

• Surgical vaginal speculum
• Scalpels, scissors, and clamps
• Electro-cautery devices
• Sutures and needle holders

Duration

The procedure typically takes 1 to 2 hours.

Setting

This procedure is usually performed in a hospital operating room or high-acuity outpatient surgical center.

Personnel

• Lead surgeon
• Assistant surgeon(s)
• Anesthesiologist or nurse anesthetist
• Surgical nurses and/or scrub techs

Risks and Complications

Common Risks:

• Bleeding
• Infection
• Pain
• Urinary tract infections

Rare Risks:

• Injury to nearby organs (e.g., bladder, bowels)
• Blood clots
• Anesthetic complications
• Vaginal vault prolapse

Benefits

• Relief from symptoms (e.g., pain, heavy bleeding)
• Improvement in quality of life
• Reduced risk of uterine or cervical cancer
• Shorter recovery time compared to abdominal hysterectomy
• No visible scarring

Recovery

• Hospital stay: 1-2 days
• Pain management: Prescribed pain medication
• Activity restrictions: Limit heavy lifting and strenuous activities for 4-6 weeks
• Follow-up appointments: 1-2 weeks post-operatively and periodically thereafter
• Full recovery: Typically within 6-8 weeks

Alternatives

• Abdominal hysterectomy
  • Pros: Can remove very large uteri or extensive endometriosis
  • Cons: Longer recovery, more visible scarring
• Laparoscopic hysterectomy
  • Pros: Minimally invasive with small incisions
  • Cons: Not always suitable for significantly enlarged uteri
• Medical management (e.g., medications, hormone therapy)
  • Pros: Non-surgical, less immediate recovery time
  • Cons: May not be effective for all conditions

Patient Experience

During the procedure, the patient will be under anesthesia and will not feel pain. Post-operatively, patients may experience some pain and discomfort, particularly in the pelvic area, which can be managed with prescribed medications. Light vaginal bleeding or discharge is common. Patients are encouraged to engage in light walking soon after surgery to promote circulation and must follow specific post-operative care instructions for a smooth recovery.