Selecting the Appropriate Technique for Vaginal Hysterectomy

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Background There are many techniques for vaginal hysterectomies. Most of those performed in the United States are variations of the classic Heaney technique. The Döderlein technique of vaginal hysterectomy has not gained wide acceptance but offers advantages in selective cases.

Methods The authors describe the Döderlein technique for vaginal hysterectomy and discuss the circumstances in which it offers advantages compared with the traditional Heaney technique.

Conclusions The traditional Heaney technique of vaginal hysterectomy is preferred for the vaginal removal of the uterus with large anterior leiomyomata or a markedly elongated cervix and uteri weighing more than 200 g. The Döderlein technique offers advantages in the vaginal removal of the markedly prolapsed uterus, when uterine descensus is lacking, or for patients with shallow or scarred posterior vaginal fornices. Familiarity with both techniques affords the surgeon the option of using the method best suiting the patient, the disease process, and concomitant conditions to be addressed during the procedure.



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