In recent years advances in laparoscopic technologies have led to renewed interest in the vaginal approach 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 an international team of experts and provides a much-needed source of up-to-date information and instruction. Importantly, the authors caution that laparoscopic technology can provide a valuable source of assistance for the gynaecological surgeon in certain circumstances, though only in a percentage of cases. This book, beautifully illustrated with line drawings and full-colour 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. Acknowledged authorities from around the world take the reader through the indications and contra-indications for the vaginal approach, explain crucial preoperative assessment procedures, and offer an evidence-based elucidation of the 'why', 'when' and 'how' of vaginal hysterectomy. Specific topics considered here include: the nulliparous patient, uterine fiboids, debulking, the use of gonadtrophin-releasing hormone agonists, oophorectomy and prophylactic oophorectomy, adnexectomy for adnexal pathology, genital prolapse, the place of sacrospinous colpopexy, urethral sphincter incompetence, hormone replacement therapy, and the psychological and sexual outcomes of hysterectomy. In addition, the authors set forth the arguments for and against vaginal hysterectomy, abdominal hysterectomy, laparoscopic assistance, and transcervical resection of the endometrium. Combined with a full review of the potential complications, morbidity and mortality associated with the vaginal approach, this book provides the reader with a well-balanced, thorough and considered appraisal of vaginal hysterectomy. As the incidence of hysterectomy worldwide continues to rise, Vaginal Hysterectomy will be an indespensable reference for practising gynaecologists, surgeons, consultants and postgraduates.
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