Highlights
- •Guidelines of the ISGE for vaginal hysterectomy for non-prolapsed uteri.
- •Two recommendations grade IB.
- •Four recommendations grade IC.
- •The vaginal route should be preferential for hysterectomy for the non-prolapsed uterus.
Abstract
Objective
The study was established by the International Society for Gynecologic Endoscopy (ISGE)
to provide evidence-based recommendations in the steps that should be undertaken in
successfully performing a vaginal hysterectomy for a non-prolapsed uterus.
Material and methods
The ISGE Task Force for vaginal hysterectomy for the non-prolapsed uterus defined
key clinical questions regarding the surgical technique, which led the Medline/PubMed
and the Cochrane Database literature search. Identified pertinent articles, published
in English from 1997 to 2019, were analysed. The available information was graded
by the level of evidence using the Grading of Recommendations, Assessment, Development
and Evaluation (GRADE) Working Group approach. The recommendations were developed
through multiple cycles of literature analysis and expert discussion.
Results
Six recommendations were established:
1. A circular incision at the level of cervico-vaginal junction is recommended (grade
IC).
2. The posterior peritoneum should be opened first (grade IC).
3. Clamping and cutting the uterosacral and cardinal ligaments before or after getting
access into anterior peritoneum is recommended (grade IC).
4. Routine closure of the peritoneum during vaginal hysterectomy is not recommended
(grade IB).
5. Vertical or horizontal closure of the vaginal vault following vaginal hysterectomy
is recommended (grade IC).
6. To insert a vaginal plug following vaginal hysterectomy is not recommended (grade
IB).
Conclusion
Vaginal hysterectomy for a non-prolapsed uterus should be the preferential route for
removing the uterus when hysterectomy is indicated. The ISGE provides evidence-based
practical guidelines on how vaginal hysterectomy for non-prolapsed uterus should be
undertaken. All efforts should be directed in teaching the surgical technique of vaginal
hysterectomy during residency.
Abbreviations:
AH (abdominal hysterectomy), GRADE (grading of recommendations, assessment, development and evaluation), ISGE (International Society for Gynecologic Endoscopy), LH (laparoscopic hysterectomy), VH (vaginal hysterectomy)Keywords
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Article info
Publication history
Published online: June 16, 2020
Accepted:
June 15,
2020
Received in revised form:
June 10,
2020
Received:
February 11,
2020
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
