Transvaginal Tubal Sterilization and Hysterectomy

Abstract

In the growing world of ever less invasive surgery, minimalist approaches to hysterectomy have begun to proliferate. Vaginal hysterectomy (VH) is an old operation—dating to antiquity—that was widely used until the advent of laparoscopic surgery, although its use has declined as minimally invasive efforts, including the robotic approach, have grown in popularity. A thorough knowledge of pelvic anatomy and positioning is required to safely perform VH. This understanding of anatomy also allows for the performance of posterior colpotomy, which can be utilized for transvaginal approaches to other abdominal operations, as described in NOTES transvaginal surgery. Other transvaginal procedures, such as culdocentesis, culdotomy, and culdoscopy, are performed in a similar manner. Strategies for employing these techniques and potential complications to avoid are discussed in detail. Transvaginal sterilization, or tubal ligation, is also described, as are the complications of the procedure.