caa a22 4500 477045618 CHVBK 20180405111329.0 cr unu---uuuuu 170330e19960701xx s 000 0 eng 10.1007/BF01907072 doi (NATIONALLICENCE)springer-10.1007/BF01907072 Vaginal axis after abdominal, vaginal and laparoscopic hysterectomy: A preliminary study with perineal ultrasonography using contrast medium [Elektronische Daten] [H. Virtanen, J. Mäkinen, M. Haarala, P. Kiilholma] Fifteen consecutive women (mean age 44.5 years) without pelvic relaxation underwent total abdominal (5), vaginal (5) and laparoscopic (5) hysterectomy for benign disease. The vaginal axes of the patients were examined prior to and on average 7 weeks (range 3-10) after the operation with perineal ultrasonography enhanced with an ultrasound contrast medium (SHU454/Echovist®-300). Transabdominal and vaginal hysterectomies were performed in the classic manner, i.e. the round as well as cardinal and sacrouterine ligaments were attached to the vaginal vault, followed by peritonealization. In laparoscopic hysterectomy the round, broad and outer parts of the uterosacral and the upper parts of the cardinal ligaments were desiccated by bipolar electrocoagulation and cut with laparoscopic scissors. The vagina was closed by interrupted sutures with no specific fixation of the round, cardinal or uterosacral ligaments. Preoperative ultrasound findings showed that in all women the vagina was an angulated organ. The mean preoperative angle between the upper and lower vaginal portions was 108°, in both the supine and the standing positions. Postoperatively this angulated shape remained almost unchanged after vaginal (mean angle 117°) and laparoscopic hysterectomy (mean angle 130°), whereas after transabdominal hysterectomy the vaginal axis rotated anteriorly and became an almost straight tube (mean angle 158°). We conclude that the vaginal axis, at least at an early stage after vaginal and laparoscopic hysterectomy remained in almost the same position as preoperatively, in contrast to that after abdominal hysterectomy. A tight attachment of the round ligaments to the vaginal vault in the abdominal approach could explain the outcome of transabdominal hysterectomy, and should be called into question. The International Urogynecology Journal, 1996 Hysterectomy nationallicence Perineal ultrasonography nationallicence Ultrasound contrast medium nationallicence Vaginal axis nationallicence Virtanen H. Department of Obstetrics and Gynecology, University Central Hospital of Turku, Kiinamyllynkatu 4-8, FIN-20520, Turku, Finland aut Mäkinen J. Department of Obstetrics and Gynecology, University Central Hospital of Turku, Kiinamyllynkatu 4-8, FIN-20520, Turku, Finland aut Haarala M. Department of Obstetrics and Gynecology, University Central Hospital of Turku, Kiinamyllynkatu 4-8, FIN-20520, Turku, Finland aut Kiilholma P. Department of Obstetrics and Gynecology, University Central Hospital of Turku, Kiinamyllynkatu 4-8, FIN-20520, Turku, Finland aut International Urogynecology Journal Springer-Verlag 7/4(1996-07-01), 196-202 0937-3462 7:4<196 1996 7 192 https://doi.org/10.1007/BF01907072 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/BF01907072 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Virtanen H. Department of Obstetrics and Gynecology, University Central Hospital of Turku, Kiinamyllynkatu 4-8, FIN-20520, Turku, Finland aut NATIONALLICENCE 700 1- Mäkinen J. Department of Obstetrics and Gynecology, University Central Hospital of Turku, Kiinamyllynkatu 4-8, FIN-20520, Turku, Finland aut NATIONALLICENCE 700 1- Haarala M. Department of Obstetrics and Gynecology, University Central Hospital of Turku, Kiinamyllynkatu 4-8, FIN-20520, Turku, Finland aut NATIONALLICENCE 700 1- Kiilholma P. Department of Obstetrics and Gynecology, University Central Hospital of Turku, Kiinamyllynkatu 4-8, FIN-20520, Turku, Finland aut NATIONALLICENCE 773 0- International Urogynecology Journal Springer-Verlag 7/4(1996-07-01), 196-202 0937-3462 7:4<196 1996 7 192 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer