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Management of the Adnexa

  • Mitchel S. Hoffman
  • William N. Spellacy

Abstract

The vaginal approach to hysterectomy is generally confined to patients in whom there is no suspicion of adnexal pathology. Removal of normal or nonadherent ovaries abdominally is straightforward, requiring little additional operative time or blood loss. Transvaginal adnexectomy is often considerably more difficult and not infrequently technically prohibitive. This chapter describes techniques for removal of the adnexa through the vagina. A laparoscopy-assisted technique is described for completeness, and the incidental finding of an ovarian tumor at the time of vaginal hysterectomy is discussed. For the transvaginal approach to adnexectomy, emphasis is placed on good surgical judgment. The surgeon not only should be able to apply a technique of adnexectomy that best suits the individual situation but must also recognise when adnexal removal is likely to be hazardous and best not attempted.

Keywords

Obstet Gynecol Ovarian Tumor Fallopian Tube Vaginal Hysterectomy Laparoscopie Hysterectomy 
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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References

  1. 1.
    Boike GM, Elfstrand EP, Delpriore G, et al. Laparoscopically assisted hysterectomy in a university hospital: repeat of 82 cases and comparison with abdominal and vaginal hysterectomy. Am J Obstet Gynecol 168:690–701, 1993Google Scholar
  2. 2.
    Daniell JF, Kurtz BR, McTavish G, et al. Laparoscopically assisted vaginal hysterectomy: the initial Nashville, Tennessee, experience. J Reprod Med 38:537–542, 1993PubMedGoogle Scholar
  3. 3.
    Davis GD, Wolgamott G, Moon J. Laparoscopically assisted vaginal hysterectomy as definitive therapy for stage III and IV endometriosis. J Reprod Med 38:577–586, 1993PubMedGoogle Scholar
  4. 4.
    Howard FM, Sanchez R. A comparison of laparoscopically assisted vaginal hysterectomy and abdominal hysterectomy. J Gynecol Surg 9:83–90, 1993PubMedCrossRefGoogle Scholar
  5. 5.
    Kovak SR, Cruikshank SH, Raho HF. Laparoscopically-assisted vaginal hysterectomy. J Gynecol Surg 6:185–193, 1990CrossRefGoogle Scholar
  6. 6.
    Lee C-L, Soong Y-K. Laparoscopic hysterectomy with the Endo GIA 30 stapler. J Reprod Med 38:582–586, 1993PubMedGoogle Scholar
  7. 7.
    Liu CY. Laparoscopic hysterectomy: report of 215 cases. Gynaecol Endosc 1:73–77, 1992Google Scholar
  8. 8.
    Nezhat F, Nezhat C, Gordon S, Wilkins E. Laparoscopic versus abdominal hysterectomy. J Reprod Med 37:247–250, 1992PubMedGoogle Scholar
  9. 9.
    Padial JG, Sotolongo J, Casey MJ, Johnson C, Osborne NG. Laparo-scopy-assisted vaginal hysterectomy: report of seventy-five consecutive cases. J Gynecol Surg 8:81–85, 1992.CrossRefGoogle Scholar
  10. 10.
    Sheth SS. The place of oophorectomy at vaginal hysterectomy. Br J Obstet Gynaecol 98:662–666, 1991PubMedCrossRefGoogle Scholar
  11. 11.
    Smale LE, Smale ML, Wilkening RL, Mundy CF, Ewing TL. Salpingo-oophorectomy at the time of vaginal hysterectomy. Am J Obstet Gynecol 131:122–128, 1978PubMedGoogle Scholar
  12. 12.
    Summitt RL Jr, Stovall TG, Lipscomb GH, Ling FW. Randomized comparison of laparoscopic-assisted vaginal hysterectomy versus standard vaginal hysterectomy in an outpatient setting. In Abstracts of the 40th Annual Meeting of ACOG, 1992Google Scholar

Suggested Reading

  1. Baggish MS. The most expensive hysterectomy [editorial]. J Gynecol Surg 8:57–58, 1992PubMedCrossRefGoogle Scholar
  2. Campbell ZB. A report on 2,798 vaginal hysterectomies. Am J Obstet Gynecol 52:598–613, 1946PubMedGoogle Scholar
  3. Capen CV, Irwin H, Magrina J, Masterson BJ. Vaginal removal of the ovaries in association with vaginal hysterectomy. J Reprod Med 28:591, 1983CrossRefGoogle Scholar
  4. Christ JE, Lotze EE. The residual ovary syndrome. Obstet Gynecol 46: 551–556, 1975PubMedGoogle Scholar
  5. Cruikshank SH. Surgical method of identifying the ureters during total vaginal hysterectomy. Obstet Gynecol 67:277–280, 1986PubMedCrossRefGoogle Scholar
  6. Daniell JF, Kurtz BR, Lee J-Y. Laparoscopic oophorectomy: comparative study of ligatures, bipolar coagulation, and automatic stapling devices. Obstet Gynecol 80:325–328, 1992PubMedGoogle Scholar
  7. DeNeff JL, Hollenbeck ZJR. The fate of ovaries preserved at the time of hysterectomy. Am J Obstet Gynecol 96:1088–1097, 1967Google Scholar
  8. Donnez JS, Nisolle M. Laparoscopic supracervical (subtotal) hysterectomy (LASH). J Gynecol Surg 9:91–94, 1993PubMedCrossRefGoogle Scholar
  9. Finazzo MS, Hoffman MS, Roberts WS, Cavanagh DM. Previous pelvic surgery in patients with ovarian cancer. South Med J 81:1518–1520, 1988PubMedCrossRefGoogle Scholar
  10. Funt MI, Benigno BB, Thompson JD. The residual adnexa: asset or liability? Am J Obstet Gynecol 129:251–254, 1977PubMedGoogle Scholar
  11. Heaney NS. A report of 565 vaginal hysterectomies performed for benign pelvic disease. Am J Obstet Gynecol 28:751–755, 1934Google Scholar
  12. Hoffman MS. Transvaginal removal of ovaries at the time of transvaginal hysterectomy utilizing the endoloop suture. Am J Obstet Gynecol 165:407–408, 1991PubMedGoogle Scholar
  13. Hughes CL Jr, Wall LL, Creasman WT. Reproductive hormone levels in gynecologic oncology patients undergoing surgical castration after spontaneous menopause. Gynecol Oncol 40:42–45, 1991PubMedCrossRefGoogle Scholar
  14. 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, 1990Google Scholar
  15. Liu CY. Laparoscopic hysterectomy: a review of 72 cases. J Reprod Med 37:351–354, 1992PubMedGoogle Scholar
  16. Mattingly RF, Thompson JD. TeLinde’s Operative Gynecology (6th ed). Lippincott, Philadelphia, 1985, pp 548–560Google Scholar
  17. McCarus SD. Laparoscopically-assisted vaginal hysterectomy. Female Patient. 17:98–102, 1992Google Scholar
  18. McKenzie LL. On discussion of the frequency of oophorectomy at the time of hysterectomy. Am J Obstet Gynecol 100:724–726, 1968Google Scholar
  19. Mikuta JM. Unexpected ovarian tumor discovered at vaginal hysterectomy. In Nichols DH, ed. Clinical Problems, Injuries, and Complications of Gynecologic Surgery (2nd ed). Williams & Wilkins, Baltimore, 1988, pp 41–42Google Scholar
  20. Minelli L, Angiolillo M, Caione C. Laparoscopically assisted vaginal hysterectomy. Endoscopy 23:64–66, 1991PubMedCrossRefGoogle Scholar
  21. Nezhat C, Nezhat F, Silfen SL. Laparoscopic hysterectomy and bilateral salpingo-oophorectomy using multifire GIA surgical stapler. J Gynecol Surg 6:287–288, 1990.CrossRefGoogle Scholar
  22. Nezhat F, Nezhat C, Silfen SL. Videolaseroscopy for oophorectomy. Am J Obstet Gynecol 165:1323–1330, 1991PubMedGoogle Scholar
  23. Nichols DH, Randall CL. Vaginal Surgery (3rd ed). Williams & Wilkins, Baltimore, 1989, pp 182–238Google Scholar
  24. Pitkin RM. Operative laparoscopy: surgical advance or technical gimmick? Obstet Gynecol 79:441–442, 1992PubMedCrossRefGoogle Scholar
  25. Porges RF. Vaginal hysterectomy at Bellevue Hospital: an experience in teaching residents, 1963–1967. Obstet Gynecol 35:300–313, 1970PubMedGoogle Scholar
  26. Pratt JH, Daikoku NH. Obesity and vaginal hysterectomy. J Reprod Med 35:945–949, 1990PubMedGoogle Scholar
  27. Reich H, DeCapria J, McGlynn F. Laparoscopic hysterectomy. J Gynecol Surg 5:213–215, 1989CrossRefGoogle Scholar
  28. Schwartz RO. Complications of laparoscopic hysterectomy. Obstet Gynecol 81:1022–1024, 1993PubMedGoogle Scholar
  29. Sightler SE, Boike GM, Estape RE, Averette HE. Ovarian cancer in women with prior hysterectomy: 14 year experience at the University of Miami. Obstet Gynecol 78:681–684, 1991PubMedGoogle Scholar
  30. Speroff T, Dawson NV, Speroff L, Haber RJ. A risk-benefit analysis of elective bilateral oophorectomy: effect of changes in compliance with estrogen therapy on outcome. Am J Obstet Gynecol 164:165–174, 1991PubMedGoogle Scholar
  31. Tadir Y. Laparoscopic hysterectomy: reinventing the wheel? Am J Obstet Gynecol 167:296–297, 1992PubMedGoogle Scholar
  32. Tadir Y, Fisch B. Operative laparoscopy: a challenge for general gynecology? Am J Obstet Gynecol 169:7–12, 1993PubMedGoogle Scholar
  33. Tasche LW. 1700 vaginal hysterectomies in a general surgical practice. Minn Med 51:1705–1711, 1968PubMedGoogle 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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