Surgeons can perform hysterectomy through more than a few different methods. Some of the generally performed routes of hysterectomy are vaginal, abdominal, laparoscopic, and robotic-assisted. Vaginal hysterectomy ranks as one of the least and minimally invasive types of hysterectomies, and it has better outcomes and fewer complications compared to other types. It should be regarded as the preferred route of hysterectomy, whenever possible. The advantages of vaginal hysterectomy include less pain, rapid recovery, faster return to work, lower costs, and lower morbidity. It is usually performed for benign hysterectomies.
Hysterectomy can be performed through more than a few different ways. Some of the generally performed routes of hysterectomy are vaginal, abdominal, laparoscopic, and robotic-assisted. Vaginal hysterectomy is considered as one of the least and minimally invasive types of hysterectomies, and it has better outcomes and fewer complications compared to other types. It should be regarded as the preferred route of hysterectomy, whenever possible. The advantages of vaginal hysterectomy include less pain, rapid recovery, faster return to work, lower costs, and lower morbidity. It is usually performed for benign hysterectomies.
Hysterectomy is one of the most frequently performed surgeries in the world, and some of the most common indications for hysterectomy include:
There are no absolute contraindications, but, some of the relative contraindications to vaginal hysterectomy are:
The instruments required for vaginal hysterectomy are the following:
Preparation of the patient includes the following:
Urinary bladder and ureteral injuries are the most common preventable complications that can occur during the hysterectomy. The technique for performing a hysterectomy is as follows:
Incorporate the uterosacral ligaments into the angle of the vaginal cuff at the time of cuff closure for the suspensory support of the vagina. This maneuver prevents the future vaginal wall prolapse.
The vagina is not usually packed as it has not shown to improve bleeding or any other outcomes.
A Foley catheter is left in place until the patient is ambulatory.
Diet is advanced as tolerated.
Complications during a hysterectomy are divided into:
A. Intraoperative complications
B. Postoperative complications
Ureteral injuries during a hysterectomy, most commonly occur at the following sites while:
N.B. The details of the management of complications of hysterectomy are outside the scope of this article.
Vaginal hysterectomy is considered as one of the minimally invasive forms of hysterectomies with better outcomes and fewer complications. It should be viewed as the preferred mode of hysterectomy whenever possible. The advantages of vaginal hysterectomy include less pain, rapid recovery, faster return to work, lower costs, and lower morbidity. It is usually performed for benign reasons.
Hysterectomy can majorly impact a patient's quality of life and can have long-term physical, psychological, and mental health effects. Healthcare practitioners should thoroughly counsel patients before hysterectomy so that they can make informed decisions about their treatment.
Vaginal hysterectomy (VH) is a very common gynecological procedure that is used to treat a wide range of gynecological pathologies. A vaginal hysterectomy procedure incorporates the coordinated collaboration among the members of the interprofessional team. The nurse has a crucial role before, during, and after the VH procedure. Before the procedure, the nurse should assist the clinician in providing the woman and her family with the necessary information leaflets about the procedure, its benefits, and risks. The nurse should assist the clinician in the preoperative preparation of patients and ensuring that all preoperative investigations are readily available before the scheduled VH procedure. During the procedure, the nurse should assist the clinician in handling the necessary tools and ensuring the proper lighting to obtain the maximum visualization of the surgical field. The nurse must ensure that the diathermy equipment is connected and the patient is correctly insulated. The nurse has a paramount role in counting the instruments and towels used during the procedure and documenting the intraoperative blood loss. After the procedure, the nurse should monitor the vital signs of the woman and ensure that the woman's general and hemodynamic status is stable. The nurse should report any untoward changes in the vital signs of the patient to the clinician. Effective and clear communication among the members of the interprofessional team is mandatory to optimize patient outcomes. The interprofessional team needs to ensure patient safety at all times. Patient education is a key to successful vaginal hysterectomy procedures. The nurse should ensure that the woman is well-informed about the procedure, and her concerns are addressed appropriately. The only way to achieve the best standard outcome for women undergoing vaginal hysterectomy and their families is through coordinated care among the members of the interprofessional team. [Level 5]
Interprofessional teamwork is essential during and after hysterectomy. The goal of the nursing intervention is prevention or minimization of complications, pain management, support, and help optimum recovery. Nursing care is essential from the day of admission to discharge. The primary responsibilities include but are not limited to 1. Preoperative preparation, 2. intraoperative coordination of the surgery, as well as 3. postoperative pain management, diet advancement, bladder, and bowel care, mobility and physical therapy, breathing exercises, wound care, personal hygiene, and monitoring of the vaginal bleeding. Nursing actions and interventions are one of the essential aspects of hysterectomy procedures.
Simulation-based training is a very effective method to advance the knowledge and skills of the providers. The simulation model has shown promise for teaching vaginal uterine morcellation skills. Providers have commented that the simulation is a good starting point for residents in training and provided a good overall approximation of vaginal morcellation.
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