**6. Local hemodynamic changes during vaginal hysterectomy**


Unlike abdominal hysterectomy, regardless of the method, open or laparoscopic, vaginal hysterectomy produces a particularly favorable effect by reducing bleeding, especially in the case of large uteri due to special hemodynamic conditions. During a vaginal hysterectomy, a series of hemodynamic events occur concerning the uterine circulation, especially for a large uterus:

Traction exerts on the cervix of a large uterus almost throughout the operation, so that blood flow is significantly diminished. After the bilateral ligature of the uterine arteries, which can affect both the ascending and the descending branches, the blood flow is completely stopped, allowing maneuvers for dimensional reduction of the uterus with no risk of significant bleeding.

During the vaginal hysterectomy, after the ligature of uterine arteries, visible bleeding does not come from vascular pedicles but from blood stored in the myometer.
