[From the anatomy to the technic of vaginal hysterectomy]

The technical difficulties in the vaginal hysterectomy (VH) are principally raised by the special conceptualization of the normal anatomy in the craniocaudal direction and the topographical modifications from the surgical manipulations. These modifications have been studied during an operative dissection on a dead body non-formulated, but with the vessels previously injected with coloured latex. Our observation and the numerous works of per-operative radiology are showing that, at every period of the VH there is an ureterical safety margin much more important than in the abdominal hysterectomy. The prime manipulation in its realization is the caudal and continuous traction of the cervix in order to individualize the ligaments and to make easier the dissections. The operation amounts to three primary stages: breaking away the uterus from its visceral connections in order to hold them distant with valves; releasing the uterus from its ligaments with ligatures spaced from the cervix to the fundus; restituating the peritoneal cavity and the vaginal fornix in its topography and statics. The vaginal hysterectomy has notable advantages in swiftness, absence of intestinal manipulations and scarceness of ureterical injuries. The anatomical limits in the low way, depend on the vaginal compliance, the mobility of the pelvic organs and the disproportion between the vagina and the deferent duct.