Reviving the Vaginal Hysterectomy!

Contributed by: John Adler, MD, Assistant Professor of Obstetrics & Gynecology

Fifty years ago, the ability to perform a vaginal hysterectomy distinguished the gynecologist from the general surgeon. Much professional pride was taken by surgeons who could remove a uterus through a small vaginal incision instead of a large abdominal incision called laparotomy.

Many of us who finished our OG/GYN training prior to the mid-1990s received a fabulous education in this technique by skilled and dedicated vaginal surgeons. We experienced firsthand the satisfaction the patients felt when they had no pain or scarring from abdominal incisions, rapid post-operative recoveries and less workplace difficulties due to their incisional pain. It was truly “minimally invasive!”

However, due to the development of new laparoscopic technologies, the vaginal hysterectomy approach was gradually replaced and nearly forgotten as the great mentors retired or died. It is now used only by those of us who have had the proper training and experience and feel passionate about its value to our patients.

I have had a gynecologic surgical practice in Cincinnati for 32 years. Vaginal hysterectomy has always been my first preference for patients who are the right candidates. My role at the Women’s Center is to offer this option to those patients who desire the vaginal approach and to counsel them as to other surgical options if they are not the right candidates. There are limitations to this procedure that should be addressed by the patient and an experienced gynecologic surgeon.

I also recognize the important options of the laparoscopic, robotic and laparotomy approaches. The surgical options should be individualized for each woman depending on the reason of her hysterectomy and her risk factors. Every patient considering a hysterectomy should ask their gynecologist if they are a candidate for the vaginal approach and seek a second opinion if their doctor is not skilled in this form of surgery.

At the Women’s Center, we have several gynecologists who are well-trained and experienced in performing vaginal hysterectomy. We are devoting our efforts to reviving this option as a first choice in women’s surgical care and to mentoring younger surgeons in the renaissance of this technique.

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