Vaginal Hysterectomy Operative Considerations

Preoperative Positioning and Access

Positioning the patient in dorsal lithotomy optimizes surgical visualization of the pelvis and allows access to the vagina and bladder, providing superior exposure compared to supine positioning for vaginal procedures 1
Avoid forced placental removal if performing peripartum hysterectomy, as this causes profuse hemorrhage; leave placenta in situ when accreta spectrum is present, and total hysterectomy is usually required rather than supracervical approach, as lower uterine segment bleeding frequently precludes leaving the cervix 1

Vaginal hysterectomy offers shorter operating times compared to both abdominal and laparoscopic approaches, resulting in faster return to normal activities and better quality of life compared to abdominal hysterectomy, with lower infection rates and shorter hospital stays consistently demonstrated with vaginal versus abdominal routes 2