**Meet the editors**

Dr Al-Hendy graduated from Zagazig University, Egypt in 1986. He earned his PhD from Turku University, Finland and gained additional postdoctoral training in gene therapy and clinical molecular genetics at McMaster and McGill Universities in Canada, clinical residency in OB/GYN at University of Saskatchewan, and fellowship training in laparoscopic surgery at Toronto University,

Canada. In USA, Dr. Al-Hendy held various faculty positions at UTMB before moving to Tennessee, where he appointed as Professor and Vice Chair of the OB/GYN Department, Scientific Director of the CWHR at Meharry Medical College, Adj. professor at Vanderbilt University. In 2010 Dr. Al-Hendy's was awarded the ASRM Ira and Ester Rosenwaks Award for his significant contribution to the Reproductive Biology field.

Dr Sabry is an assistant Lecturer of OB/GYN at Sohag University, Egypt. He earned his M.D. degree in 1999 from South Valley University, Egypt. After completing his residency training, he earned his Master degree in OB/GYN in 2007 from Sohag University, Egypt. Dr Sabry spent 3 years of fellowship training at Meharry Medical College, USA; during which he earned the Certificate

of the American Registry of Diagnostic Medical Sonography, and shared through his publications and presentations in many national and international meetings focusing in the areas of ovarian biology, female infertility as well as developing novel medical treatment for uterine fibroids.

Contents

**Preface IX** 

Chapter 2 **Subtotal Versus Total** 

Zouhair Amarin

Chapter 4 **The Role of Modified Radical** 

Chapter 5 **New Approaches to Hysterectomy** 

Chapter 6 **Emergency Peripartum Hysterectomy 85** 

Shanti Raju-Kankipati and Omer Devaja

Abiodun Omole-Ohonsi

S. Masheer and N. Najmi

Chapter 7 **Peripartum Hysterectomy 93**  Chisara C. Umezurike and Charles A. Adisa

Chapter 8 **Peripartum Hysterectomy** 

Chapter 3 **Robotic Surgery Versus** 

**Part 1 Types of Hysterectomy 1** 

Chapter 1 **Techniques of Hysterectomy 3**  Nirmala Duhan

**Abdominal Hysterectomy for** 

**Abdominal and Laparoscopic** 

**Benign Gynecological Conditions 23** 

E. Ancuta, Codrina Ancuta and L. Gutu

Masamichi Hiura and Takayoshi Nogawa

**by Minimal Invasive Surgery (MIS) 75** 

**Versus Non Obstetrical Hysterectomy 103** 

**Radical Hysterectomy in Cervical Cancer 31** 

**Hysterectomy in Endometrial Carcinoma 51** 

## Contents

## **Preface XIII**


X Contents


Contents VII

Chapter 19 **Sacrocolpopexy for Post Hysterectomy Vault Prolapse 293**

Chapter 20 **Urinary Tract Injuries in Low-Resource Settings 313** 

**Conization and Radical Trachelectomy 325** 

**the Effect of the Male Hormone on Uterus in the Female to Male Transsexuals 335** Seok Kwun Kim and Myoungseok Han

**Hysterectomy & Postoperative Care 365** Amitabha Majumdar and Sepeedeh Saleh

Beata Pięta, Joanna Buks and Tomasz Opala

Chapter 26 **Predictive Value of Cellular Immune Response and**

E. Ancuta, Codrina Ancuta and D. Sofroni

Chapter 25 **What Do We Know About Hysterectomy? 393**

Chapter 23 **The Role of Prophylactic Oophorectomy in the Management** 

Karolina Chmaj-Wierzchowska, Marcin Wierzchowski,

**Tumor Biomarkers in Patients Surgically Treated for Cervical Cancer in Relation to Clinical Outcomes 409**

**of Hereditary Breast & Ovarian Cancer Syndrome 345** 

**Part 6 Hysterectomy: Multiple Aspects 323**

Keun-Young Lee and Ji-Eun Song

Chapter 22 **Know-How of the Hormonal Therapy and** 

A.J. Lowery and K.J. Sweeney

Chapter 24 **Psychological Aspects of** 

Mathias Onsrud

Chapter 21 **Management of Pregnancy After** 

Serge P. Marinkovic, Lisa M. Gillin and Christina M. Marinkovic

	- **Part 6 Hysterectomy: Multiple Aspects 323**

VI Contents

**Part 2 Alternatives to Hysterectomy 113**

**to Decrease Rate of Hysterectomy 115**

**Levonorgestrel Intrauterine System 159** 

**Hysterectomy in Treating Uterine Fibroids? 169**

**Bleedings as Alternative to Hysterectomy 197**

**Part 3 Hysterectomy Pre-Operative Considerations 223** 

**Postoperative Hysterectomy Patients 251** Sepeedeh Saleh and Amitabha Majumdar

**After Hysterectomy – A Simple Approach 269** Mariana Calderon, Guillermo Castorena and Emina Pasic

Manoel Afonso Guimarães Gonçalves, Fernando Anschau, Daniela Martins Gonçalves and Chrystiane da Silva Marc

**Various Hysterectomy Techniques 285** 

Chapter 15 **Hysterectomy: Advances in Perioperative Care 225** Kenneth Jensen and Jens Børglum

**Alternative for Hysterectomy 129** Chang-Sheng Yin and Fung-Wei Chang

Chapter 11 **The LNG-IUS: The First Choice Alternative to** 

Mohamed Y. Abdel-Rahman, Mohamed Sabry and Ayman Al-Hendy

**Hysterectomy? Intrauterine Levonorgestrel-Releasing Systems for Effective Treatment and Contraception 141** 

Chapter 9 **Medical Treatment of Fibroid** 

Chapter 10 **Hysteroscopic Surgery as an** 

D. Wildemeersch

Johnstone Shabaya Miheso

Chapter 14 **Pharmacotherapy of Massive Obstetric**

Andrey Momot, Irina Molchanova, Vitaly Tskhai and Andrey Mamaev

**Part 4 Hysterectomy Post-Operative Care 249**

Chapter 12 **Menorrhagia and the** 

Chapter 13 **Is Embolization Equal to**

Tomislav Strinic

Chapter 16 **Innovations in the Care of** 

Chapter 17 **Postoperative Pain Management** 

Chapter 18 **Ureter: How to Avoid Injuries in** 

**Part 5 Hysterectomy Complications 283**


Preface

This book is intended for the general and family practitioners, as well as for gynecologists, specialists in gynecological surgery, general surgeons, urologists and all other surgical specialists that perform procedures in or around the female pelvis, in addition to intensives and all other specialities and health care professionals who care for women before, during or after hysterectomy. While removal of the uterus using newer techniques such as laparoscopic and robotic hysterectomy attract the most attention of both the patients as well as the practitioners, still, for most women, especially in low resources countries, the conventional hysterectomy, abdominal or vaginal, is considered the intervention of choice for removing the uterus. Such techniques have withstood the test of time and can be performed in almost any small or midsized surgical hospital without the need to travel to distant specialty hospitals. It is the aim of this book to review the recent achievements of the research community regarding the field of gynecologic surgery and hysterectomy as well as highlight future directions and where this field is heading. While no single volume can adequately cover the diversity of issues and facets in relation to such a common and important procedure such as hysterectomy, this book will attempt to address the pivotal topics especially in

regards to safety, risk management as well as pre- and post-operative care.

respect and love as they are our daughters, sisters and mothers, all the time.

Finally, we dedicate this book to our wonderful prior, current and future patients for whom we strive for excellence and beyond, as we care for them with full and most

Professor, Vice Chair and Scientific Director, Department of Obstetrics and Gynecology, Center of Women Health Research, Meharry Medical College, Nashville, Tennessee, Adjunct professor, Vanderbilt University and Vanderbilt University Medical Center,

Department of Obstetrics and Gynecology, Sohag University Hospitals, Sohag,

Center for Women's Health Research, Department of Obstetrics and Gynecology,

**Ayman Al-Hendy, MD, PhD**

Nashville, Tennessee,

**Mohamed Sabry, MD**

Meharry Medical College, Nashville, Tennessee,

USA

Egypt

USA

## Preface

This book is intended for the general and family practitioners, as well as for gynecologists, specialists in gynecological surgery, general surgeons, urologists and all other surgical specialists that perform procedures in or around the female pelvis, in addition to intensives and all other specialities and health care professionals who care for women before, during or after hysterectomy. While removal of the uterus using newer techniques such as laparoscopic and robotic hysterectomy attract the most attention of both the patients as well as the practitioners, still, for most women, especially in low resources countries, the conventional hysterectomy, abdominal or vaginal, is considered the intervention of choice for removing the uterus. Such techniques have withstood the test of time and can be performed in almost any small or midsized surgical hospital without the need to travel to distant specialty hospitals.

It is the aim of this book to review the recent achievements of the research community regarding the field of gynecologic surgery and hysterectomy as well as highlight future directions and where this field is heading. While no single volume can adequately cover the diversity of issues and facets in relation to such a common and important procedure such as hysterectomy, this book will attempt to address the pivotal topics especially in regards to safety, risk management as well as pre- and post-operative care.

Finally, we dedicate this book to our wonderful prior, current and future patients for whom we strive for excellence and beyond, as we care for them with full and most respect and love as they are our daughters, sisters and mothers, all the time.

#### **Ayman Al-Hendy, MD, PhD**

Professor, Vice Chair and Scientific Director, Department of Obstetrics and Gynecology, Center of Women Health Research, Meharry Medical College, Nashville, Tennessee, Adjunct professor, Vanderbilt University and Vanderbilt University Medical Center, Nashville, Tennessee, USA

#### **Mohamed Sabry, MD**

Department of Obstetrics and Gynecology, Sohag University Hospitals, Sohag, Egypt Center for Women's Health Research, Department of Obstetrics and Gynecology, Meharry Medical College, Nashville, Tennessee, USA

**Part 1** 

**Types of Hysterectomy** 

**Part 1** 

**Types of Hysterectomy** 

**1**

*India* 

Nirmala Duhan

**Techniques of Hysterectomy** 

*Pt B D Sharma Post Graduate Institute of Medical Sciences, ROHTAK,* 

Hysterectomy is the most common operation performed for gynecological disorders, second only to caesarean section. Annual medical costs related to hysterectomy exceed \$ 5 billion in the US. Overall hysterectomy rates vary from 1.2 to 4.8 per 1000 women. Development of alternatives to hysterectomy like use of different energy sources for endometrial ablation and the availability of progestational intrauterine system for symptomatic uterine bleeding have led to a reduction in rates of hysterectomy in recent years. Besides, leiomyomas which have conventionally formed one of the important indications of hysterectomy in women in whom fertility conservation is not an issue, are now increasingly being managed by transcervical hysteroscopic resection (submucous myomas), transcatheter uterine artery embolization and magnetic resonance guided focussed ultrasound energy. These new, less invasive and safer management techniques coupled with the desire to avoid major surgery,

Even though alternatives to hysterectomy are being explored for benign conditions, hysterectomy continues to have a place in its definitiveness. Uterine myomas continue to form the indications for 40% of all abdominal hysterectomies, the others being endometriosis (12.8%), malignancy (12.6%), abnormal uterine bleeding (9.5%), pelvic inflammatory disease (3.7%) and uterine prolapse (3.0%). Prolapse forms the indication for 44% of all vaginal hysterectomies. In recent years, non – descent vaginal hysterectomy (NDVH) is being tried for most benign conditions and uteri of upto 12 weeks gestational size can be safely removed intact per vaginum. For moderate to large sized uteri with benign conditions, techniques like removal of wedge, bisection, coring and morcellation may be adopted in an attempt to reduce the uterine volume prior to removal. However, large leiomyomas, pelvic inflammatory disease, malignancy (invasive cervical cancer, endometrial carcinoma, ovarian and fallopian tube cancer and gestational trophoblastic tumors) and most suspicious adnexal masses may still be better approached abdominally.

The uterus may be removed abdominally or vaginally or by a combination of the two routes. Abdominal approach may further be categorized as open abdominal or laparoscopic.

**1. Introduction**

have added to the reduction in hysterectomy rates.

**1.2 Approaching the uterus: Abdominally or vaginally** 

**1.1 Indications for hysterectomy** 

*Department of Obstetrics and Gynecology,* 
