Abstract
Although laparoscopic surgery or robotic surgery has recently been the main procedure
adopted for managing benign uterine tumors, abdominal total hysterectomy must still
be learned as a basic surgical skill for obstetricians and gynecologists. Total hysterectomy
is divided into two types: the extrafascial and intrafascial approaches. Intrafascial
hysterectomy, represented by the Aldridge's method, is a useful and safe procedure
for treatment when the patient has no cervical malignancy, including cervical intraepithelial
neoplasia. Furthermore, the intrafascial approach is safely performed even in patients
with firm adhesion in the Douglas's pouch and/or around the uterine cervix due to
endometriosis, pelvic inflammatory diseases, or a history of intrapelvic surgery.
The intrafascial approach can also effectively prevent descent of the vaginal stump
after hysterectomy via the partial preservation of the uterine retinaculum. Although
the Aldridge's method was originally reported to start via an intrafascial approach
at the position of the internal cervical os using scissors, Dr. Kiichiro Noda created
a modified version of the procedure that increases its ease and safety by changing
the position and management of the parametrial tissue including the uterine artery.
The details of this modified Aldridge's procedure using Noda's method are explained
below.
Keywords
abdominal hysterectomy - intrafascial method - Aldridge's procedure - gynecologic
surgery - benign tumor
