Adnexectomy During Vaginal Hysterectomy for Benign Indications Using Bipolar Hemostasis of Lateral Pedicles and Transvaginal Adnexa Mobilization

Background: Using coagulation techniques to achieve hemostasis of lateral pedicles, or a fiberoptic light source to improve visibility in a narrow operating field, or transvaginal mobilization of adhered adnexa, may facilitate more salpingo-oophorectomies after vaginal hysterectomies for benign indications. Objectives: The aim of this research was to study the feasibility of adnexectomy during vaginal hysterectomy for benign indications, using bipolar coagulation to achieve hemostasis of the lateral pedicles and using transvaginal mobilization of adnexa. Materials and Methods: A prospective observational study was conducted from May 2010 through April 2014. Consecutive candidates for vaginal hysterectomy for benign nonprolapsed indications with adnexectomy (unilateral or bilateral) were included. The outcome of interest was success of adnexectomy during vaginal hysterectomy. Results: Adnexectomy during vaginal hysterectomy was completed successfully in 220 (97.34%) of 226 indicated cases. Unilateral adnexectomy was performed in 148 (65.48%), and bilateral adnexectomy was performed in 78 (34.51%) cases. Adnexectomy during vaginal hysterectomy failed in 6 (2.65%) cases. These patients had adhered ovaries above the pelvis, could not be mobilized vaginally, and, finally, needed laparoscopic completion of adnexectomy. Conclusions: Most adnexectomies during vaginal hysterectomy for benign indications can be completed, using bipolar hemostasis and transvaginal mobilization of adhered adnexa in the pelvis. Some failed adnexectomies during vaginal hysterectomies might need laparoscopic completions to avoid laparotomies. (J GYNECOL SURG 31:86)