Vaginal hysterectomy is the only available option that is feasible without total anaesthesia or in outpatient settings ( although so far doing it without anesthesia is recommended only in exceptional cases ).
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But two studies in this week's New England Journal show that one alternative _ laparoscopically assisted vaginal hysterectomy _ is more expensive than traditional surgery because it takes more time and involves costly, disposable instruments.
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Whenever possible, concluded Dr . Robert L . Summitt, Jr ., a gynecologist at the University of Tennessee and a co-author of an editorial in the New England Journal, a simple vaginal hysterectomy is the procedure of choice.
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When a fibroid has enlarged, treatment with a synthetic hormone, called a GRH analogue, that temporarily shuts off estrogen production can often shrink it by 50 percent, down to a size that can be treated by a vaginal hysterectomy.
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Endometriosis may spread to the cervix and vagina or to sites of a surgical abdominal incision, known as " scar endometriosis . " Risk factors for scar endometriosis include previous abdominal surgeries, such as a hysterotomy or cesarean section, or ectopic pregnancies, salpingostomy puerperal sterilization, laparoscopy, amniocentesis, appendectomy, episiotomy, vaginal hysterectomies, and hernia repair.
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Laparoscopes have been used in what are known as laparoscopically assisted vaginal hysterectomies ( LAVHs ) for about 10 years, but with the older procedure, the uterus and cervix as well as benign tumors are removed through an incision in the interior of the vagina, rather than through one of the small incisions in the abdomen.
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