Use baby formula to check for bladder integrity

Dr. Gebhart responds
Dr. Raymond, I thank you for your comments and question. I applaud your surgical skill set and approach to hysterectomy. My preferred route of hysterectomy for benign disease is the vaginal route. A few years ago we published an article in OBG Management on keys to success in vaginal hysterectomy.¹ Indeed, the vaginal approach remains the least expensive and least morbid approach to hysterectomy, yet the least common. I continue to publish and lecture on the benefits of a vaginal approach and societies, such as the Society of Gynecologic Surgeons (SGS), remain committed to teaching and advocating this well-established, evidence-based yet underutilized approach.

Given the interest and controversy in the use of power morcellation after the FDA’s Safety Communication last April,² it was felt that a good technical review of abdominal hysterectomy was cogent. If surgeons have a concern about using power morcellation or their institution has banned use of a power morcellator, then the abdominal route is the most likely alternative for removing the enlarged uterus intact. As you state, the abdominal approach remains the most common route of hysterectomy. My sense is that most providers faced with an enlarged uterus that cannot be removed via laparoscopic morcellation (for reasons stated previously) are likely to turn to abdominal hysterectomy. Hopefully, the article gives readers a chance to assess and develop their technical approach to abdominal hysterectomy.

References

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