Intraoperative Complications

  • Mitchel S. Hoffman
  • William N. Spellacy


Significant intraoperative complications are an infrequent occurrence during vaginal hysterectomy. It is that very infrequency that catches the surgeon off guard and creates an uncertainty about how to proceed. The relatively limited exposure afforded during vaginal surgery compounds the uncertainty of the surgeon and increases the difficulty of managing certain complications. This chapter discusses the prevention, récognition, and management of the more common intraoperative complications that occur during vaginal hysterectomy. With proper attention to detail, most complications can be recognised and effectively managed transvaginally. Cystoscopy is a useful adjuvant in the armamentarium of the gynecologic surgeon, and familiarity with and liberal use of this procedure are encouraged. For complicated urologic injuries (ureteral, bladder base), one should not hesitate to obtain help from a urologist.


Obstet Gynecol Vaginal Hysterectomy Indigo Carmine Ureteral Injury Ureteral Orifice 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Browne DS, Frazer ML Hysterectomy revisited. Aust NZ J Obstet Gynaecol 31:148–152, 1991CrossRefGoogle Scholar
  2. 2.
    Copenhaver EH. Vaginal hysterectomy: an analysis of indication and complications among 1,000 operations. Am J Obstet Gynecol 84:123–128, 1962PubMedGoogle Scholar
  3. 3.
    Cruikshank SH, Kovac SR. Anatomic changes of ureter during vaginal hysterectomy. Contemp Obstet Gynecol February:38–53, 1993Google Scholar
  4. 4.
    Dicker RC, Greenspan JR, Strauss LT, et al. Complications of abdominal and vaginal hysterectomy among women of reproductive age in the United States: the collaborative review of sterilization. Am J Obstet Gynecol 144:841–848, 1982PubMedGoogle Scholar
  5. 5.
    Falk HC, Bunkin IA. A study of 500 vaginal hysterectomies. Am J Obstet Gynecol 52:623–630, 1946PubMedGoogle Scholar
  6. 6.
    Gitsch G, Berger E, Tatra G. Trends in thirty years of vaginal hysterectomy. Surg Gynecol Obstet 172:207–210, 1991PubMedGoogle Scholar
  7. 7.
    Gray LA. Indications, techniques, and complications in vaginal hysterectomy. Obstet Gynecol 28:714–722, 1966PubMedGoogle Scholar
  8. 8.
    Hofmeister FJ, Wolfgram RL. Methods of demonstrating measurement relationships between vaginal hysterectomy ligatures and the ureters. Am J Obstet Gynecol 83:938–948, 1962PubMedGoogle Scholar
  9. 9.
    Ledger WJ, Campbell C, Wilson JR. Postoperative adnexal infections. Obstet Gynecol 31:83–89, 1968PubMedCrossRefGoogle Scholar
  10. 10.
    Livengood CH III, Addison WA. Adnexal abscess as a delayed complication of vaginal hysterectomy. Am J Obstet Gynecol 143:596–597, 1982PubMedGoogle Scholar
  11. 11.
    Perineau M, Monrozies X, Reme JM. Complications of hysterectomy. Rev Fr Gynecol Obstet 87:120–125, 1992PubMedGoogle Scholar
  12. 12.
    Pratt JH, Daikoku NH. Obesity and vaginal hysterectomy. J Reprod Med 35:945–949, 1990PubMedGoogle Scholar
  13. 13.
    Pratt JH, Galloway JR. Vaginal hysterectomy in patients less than 36 or more than 60 years of age. Am J Obstet Gynecol 84:123–128, 1962Google Scholar
  14. 14.
    Rosenzweig BA, Seifer DB, Grant WD, et al. Urologic injury during vaginal hysterectomy: a case-control study. J Gynecol Surg 6:27–32, 1990CrossRefGoogle Scholar
  15. 15.
    Stanhope CR, Wilson TO, Utz WJ, Smith LH, O’Brien PC. Suture entrapment and secondary ureteral obstruction. Am J Obstet Gynecol 164:1513–1519, 1991PubMedGoogle Scholar

Suggested Reading

  1. Heaney NS. A report of 565 vaginal hysterectomies performed for benign pelvic disease. Am J Obstet Gynecol 28:751–755, 1934Google Scholar
  2. Kudo R, Yamauchi O, Okazaki T, et al. Vaginal hysterectomy without ligation of the ligaments of the cervix uteri. Surg Obstet Gynecol 170:299–305, 1990Google Scholar
  3. Leventhal ML, Lazarus ML. Total abdominal and vaginal hysterectomy, a comparison. Am J Obstet Gynecol 61:289–299, 1951PubMedGoogle Scholar
  4. Pratt JH. Operative and postoperative difficulties of vaginal hysterectomy. Obstet Gynecol 21:220–226, 1963PubMedGoogle Scholar
  5. Tancer ML. Observations on prevention and management of vesicovaginal fistula after total hysterectomy. Surg Gynecol Obstet 175:501–506, 1992PubMedGoogle Scholar
  6. Tasche LW. 1700 Vaginal hysterectomies in a general surgical practice. Minn Med 51:1705–1711, 1968.PubMedGoogle Scholar
  7. White SC, Watel LJ, Wade ME. Comparison of abdominal and vaginal hysterectomies: a review of 600 operations. Obstet Gynecol 37:530–537, 1971PubMedGoogle Scholar
  8. Wilson JR, Black JR. Ovarian abscess. Am J Obstet Gynecol 90:34–43, 1964Google Scholar

Copyright information

© Springer Science+Business Media New York 1995

Authors and Affiliations

  • Mitchel S. Hoffman
    • 1
  • William N. Spellacy
    • 1
  1. 1.Department of Obstetrics-GynecologyUniversity of South Florida, College of MedicineTampaUSA

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