Lack of Descensus

  • Mitchel S. Hoffman
  • William N. Spellacy


Methods for overcoming the obstacle of uterine enlargement when performing a vaginal hysterectomy were discussed in Chapter 5. Another significant obstacle to the vaginal approach is a significant lack of uterine descensus. Many other anatomic factors play an important role in the feasibility of vaginal hysterectomy. With experience and good judgment, the surgeon is usually able to select patients for vaginal hysterectomy in whom a relative lack of descensus can be readily overcome. Some operative techniques are described that help the surgeon obtain access to the more superiorly placed pedicles encountered with these uteri. Access to the ovarian pedicles is not necessarily as difficulty and they should be approached on an individual basis as is discussed.


Vaginal Hysterectomy Uterine Descensus Needle Holder Vaginal Approach Cardinal Ligament 
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.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Allen E, Peterson LF. Versatility of vaginal hysterectomy technique. Obstet Gynecol 3:240–247, 1954.PubMedGoogle Scholar
  2. 2.
    Nichols DH, Randall CL. Vaginal surgery. 3rd ed. Baltimore, Maryland. Williams and Wilkins, 1989, pp 182–238.Google Scholar

Suggested Reading

  1. Barber HRK. Cystocele, urethrocele, rectocele, and enterocele. In Barber HRK, Fields DH, Kaufman SA (eds). Quick Reference to Ob-Gyn Procedures (3rd ed). Lippincott, Philadelphia, 1990, pp 356–357Google Scholar
  2. Bradford WZ, Bradford WB, Woltz JHE, Brown CW. Experiences with vaginal hysterectomy. Am J Obstet Gynecol 68:540–548, 1954PubMedGoogle Scholar
  3. Burnett LS. Relaxations, malpositions, fistulas, and incontinence. In Jones HW III, Wentz AC, Burnett LS (eds). Novak’s Textbook of Gynecology (11th ed). Williams & Wilkins, Baltimore, 1988, pp 456–457Google Scholar
  4. Campbell ZB. A report on 2,798 vaginal hysterectomies. Am J Obstet Gynecol 52:598–613, 1946PubMedGoogle Scholar
  5. Davis MR. Pelvic relaxation. In Kase NG, Weingold AB, Gershenson DM (eds). Principles and Practice of Clinical Gynecology. (2nd ed). New York: Churchhill Livingstone, 1990, p 662Google Scholar
  6. Dunnihoo DR. Fundamentals of Gynecology and Obstetrics. Lippincott, Philadelphia, 1990, p 57Google Scholar
  7. Falk HC, Bunkin IA. A study of 500 vaginal hysterectomies. Am J Obstet Gynecol 52:623–630, 1946PubMedGoogle Scholar
  8. Gray LA. Indications, techniques, and complications in vaginal hysterectomy. Obstet Gynecol 28:714–722, 1966PubMedGoogle Scholar
  9. Heaney NS. A report of 565 vaginal hysterectomies performed for benign pelvic disease. Am J Obstet Gynecol 28:751–755, 1934Google Scholar
  10. Isaacs JH. Vaginal hysterectomy. In Sciarra JJ, Droegemueller W (eds). Gynecology and Obstetrics (Vol 1). Lippincott, Philadelphia, 1990, pp 1–10Google Scholar
  11. Käser O, Iklé FA, Hirsch HA. In Friedman EA (ed). Vaginal hysterectomy and vaginal procedures for descensus. Atlas of Gynecologic Surgery (2nd ed). Thieme-Stratton, New York, 1985Google Scholar
  12. Kemp GA. The corpus uteri. In Rosenwaks Z, Benjamin F, Stone ML, (eds). Gynecology: Principles and Practice. Macmillan, New York, 1987, p 490Google Scholar
  13. Kudo R, Yamauchi O, Okazaki T, et al. Vaginal hysterectomy without ligation of the ligaments of the cervix uteri. Surg Gynecol Obstet 170:299–305, 1990PubMedGoogle Scholar
  14. Mackay EV, Beischer NA, Cox LW, Wood C. Illustrated Textbook of Gynecology. Saunders, Philadelphia, 1983, p 299Google Scholar
  15. Masterson BJ. Manual of Gynecologic Surgery (2nd ed). Springer, New York, 1986, pp 108–121Google Scholar
  16. Mattingly RF, Thompson JD. TeLinde’s Operative Gynecology (6th ed). Lippincott, Philadelphia, 1985, pp 548–560Google Scholar
  17. Netter FH. The Ciba Collection of Medical Illustrations. Vol 2. Reproductive System. Case-Hoyt Corp., Rochester, NY, 1977, p 159Google Scholar
  18. Porges RF. Changing indications for vaginal hysterectomy. Am J Obstet Gynecol 136:153–158, 1980PubMedGoogle Scholar
  19. Pratt JH, Gunnlaugsson GH. Vaginal hysterectomy by morcellation. Mayo Clin Proc 45:374–387, 1970PubMedGoogle Scholar
  20. Sheth S, Malpani A. Vaginal hysterectomy for the management of menstruation in mentally retarded women. Int J Gynaecol Obstet 35:319–321, 1991PubMedCrossRefGoogle Scholar
  21. Stander RW. Disorders of pelvic support. In Romney SL, Gray MJ, Little AB, et al. (eds). Gynecology and Obstetrics: The Health Care of Women. McGraw-Hill, New York, 1981, p 969Google Scholar
  22. Stenchever MA. Disorders of abdominal wall and pelvic support. In Droegemueller W, Herbst AL, Mishell DR Jr, Stenchever MA (eds). Comprehensive Gynecology. Mosby, St. Louis, 1987, p 530Google Scholar
  23. Symmonds RE. Relaxation of pelvic supports. In Pernoll ML, Bonson RC (eds). Current Obstetric and Gynecologic Diagnosis and Treatment. Appelton & Lange, Norwalk, CT, 1987, p 760Google Scholar
  24. Tovell HM, Danforth DN. Structural defects and relaxations. In Danforth DN, Scott JR, (eds). Obstetrics and Gynecology, (5th ed). Lippincott, Philadelphia, 1986, p 964Google Scholar
  25. Wall LL. Disorders of pelvic support and urinary incontinence. In Clarke-Pearson DL, Dawood MY, (eds). Green’s Gynecology: Essentials of Clinical Practice (4th ed). Little, Brown, Boston, 1990, pp 398–399.Google Scholar
  26. Willson JR, Carrington ER, Ledger WJ, Laras RK Jr, Mattox JH. Obstetrics and Gynecology (8th ed). Mosby, St. Louis, 1987, p 568Google Scholar
  27. Wynn RM. Obstetrics and Gynecology: The Clinical Core (4th ed). Lea & Febiger, Philadelphia, 1988, p 220Google 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

Personalised recommendations