TechniqueVaginal Access Procedures

Overview

Vaginal access procedure refers to the use of the vaginal opening to assist with the surgery. By using the vaginal opening during procedures such as hysterectomy, removal of pelvic masses or endometriosis, the surgeon limits the size and number of incisions in the abdominal wall. This decreases pain, complications, and recovery time. The following is a list of some of the more common vaginal access procedures performed by CIGC surgeons.

Uterine/Fibroid Debulking Through the Vagina

In minimally invasive hysterectomy, the uterus is either removed through the vagina using vaginal debulking techniques, or through an incision in the abdominal wall. Typically the abdominal wall incision is at least 1.5 cm in size, and can become larger if needed. This increases pain and recovery time. By using the natural vaginal opening for removal, the surgeon is not increasing the size or number of incisions in the abdominal wall.

When properly performed, this procedure is safe and very effective. CIGC surgeons use this technique extensively, and have removed very large fibroids through this approach. There is no injury to the vagina – the length, width, or integrity of the vagina is not affected. There is no change in intercourse with the use of vaginal debulking for fibroids. Patient satisfaction rates are very high with this approach, with pain minimized and faster recovery than the use of larger abdominal wall incisions.

Vaginal Cuff Closure

Closure of the vaginal cuff after hysterectomy can be accomplished either laparoscopically or vaginally. Many surgeons have difficulty closing the vaginal opening through the vaginal route, and use a laparoscopic approach, which requires more time and is less effective. Studies have clearly shown that closure vaginally results in a safer, faster, and more effective result. CIGC surgeons close the vaginal cuff in all cases, with excellent results and minimal complications.

Vaginal Removal of Pelvic Masses

In many cases, removal of a large ovarian mass is very difficult through the abdominal wall, and often a larger incision is required. This will increase pain, bleeding, herniation, and recovery time. Vaginal removal of pelvic masses is commonly used by CIGC, and requires the use of a vaginal extraction device, or bag, that envelops the mass. The bag has a purse string cord that closes the top of the bag, which can then be pulled down toward the vaginal opening. Since the vagina is accessible easily from below, and the opening is naturally larger, removal of masses is easier with much less pain associated with abdominal removal. The result is a fast, safe extraction with minimal recovery time.

Vaginal Port Applications

A vaginal port can be placed through the vagina, and instruments are used to manipulate and even dissect as required. This approach saves single and sometimes multiple abdominal wall incisions, decreasing pain and recovery times.