Total Vaginal Hysterectomy for Unprolapsed Uterus

Vaginal hysterectomy was the first method to extract the uterus. Vaginal hysterectomy goes back a long way into the history of medicine. Although the first hysterectomy was carried out by Themison of Athens in the year 20 B.C., the idea of extracting the uterus through the vagina was first mentioned in 120 B.C. by Soranus of Ephesos, a distinguished obstetrician. The first elective vaginal hysterectomy was performed by J. Conrad Langenbeck in 1813. The patient was a 50-year-old multipara, who suffered from chronic pelvic pain attributed to a prolapsed uterus with a hard, bleeding tumor. The operation was carried out in challenging conditions, without anesthesia, proper instruments, or surgical assistants. Until the early 1950s, vaginal hysterectomy was the method of choice for removing the uterus. With the widespread introduction of general anesthesia and antibiotic therapy, the site of vaginal hysterectomy was taken over by abdominal hysterectomy. With the introduction of minimally invasive surgery in gynecology, vaginal hysterectomy has regained its place. Harry Reich performed the first total laparoscopic hysterectomy in 1989, being one of the most renowned vaginal surgeons, and he still claims at the beginning of the 21st century that … when the first choice of approach for hysterectomy is possible, is the vaginal route. This chapter presents the relevant anatomy from the point of view of the vaginal surgeon and the standard technique used by the author in over 5,000 vaginal hysterectomies. All intraoperative drawings and photographs are original

Robotically Assisted Hysterectomy

Starting from the first robotic hysterectomy, currently, this method is widely accepted all over the world as an alternative to open or laparoscopic surgery due to the technical advantages it offers. We are currently using the DaVinci Xi platform, whose components, instruments, and accessories are described. This chapter aims to present all surgical steps of a robotically assisted hysterectomy, starting with patient positioning, uterine manipulator insertion, port insertion, pneumoperitoneum performing, and the operative technique of the total robotic hysterectomy: connective vascular disconnection, colpotomy, uterus retrieval, and colporrhaphy. A special mention belongs to radical robotic hysterectomy with sentinel node detection and pelvic lymphadenectomy. The chapter ends with a brief description of the perioperative complications