V10-12: A Non-Traditional Route To The Vaginal Hysterectomy: The Döderlein–Krönig Hysterectomy
Approximately 590,000 hysterectomies are performed annually in the United States. Indications for hysterectomy include leiomyomas, endometriosis and uterine prolapse. Although vaginal hysterectomy is the preferred hysterectomy method, only 22% of all hysterectomies are performed via the transvaginal route. The Heaney vaginal hysterectomy technique is the traditional surgical method taught and performed. This method does have its limitations, one of which includes decreased visualization of vascular pedicles. In 1906, Doderlein-Kronig described a vaginal hysterectomy technique that removes the uterus through an anterior colpotomy. The purpose of this video is to demonstrate an alternative and safe vaginal hysterectomy technique using the Doderlein-Kronig approach to serve as an educational tool for female pelvic surgeons of all levels.
We present the case of a 57 year-old female with symptomatic stage IIIBa uterovaginal prolapse desiring definitive surgical intervention. We performed a total vaginal hysterectomy utilizing the Doderlein-Kronig approach. An anterior colpotomy was made in the pubovesicocervical fascia, the uterus was flipped and the hysterectomy proceeded similarly to an abdominal hysterectomy. In addition, we performed a traditional uterosacral ligament colpopexy.
Our patient did well after the procedure. She was discharged home on postoperative day number one. At her 6-week follow-up, the vaginal apex was suspended well and the vaginal cuff was intact.
In women undergoing surgical removal of the uterus where a vaginal hysterectomy appears achievable, the Doderlein-Kronig vaginal hysterectomy approach should be considered. This method which is similar to an abdominal approach, is potentially easier and increases visualization of vascular pedicles. This technique may be a way to increase the number of vaginal hysterectomies in the future.