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.
KeywordsObstet Gynecol Ovarian Tumor Fallopian Tube Vaginal Hysterectomy Laparoscopie Hysterectomy
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