Re establishing a proper balance between the two methods vaginal and laparoscopic vaginal surgery demonstrates when vaginal surgery is still the first choice and how it should be performed the authors explain each procedure in full and detail the roles that each procedure should play in the repertoire of the gynecological surgeon. The advent of laparoscopic techniques has heralded a new era in vaginal surgery but it has not been without its problems and risks the many advantages have meant that it is increasingly adopted in all situations including those where the vaginal route would still be preferable for both patient and surgeon re establishing a proper balance between the two methods vaginal and laparoscopic vaginal surgery demonstrates when vaginal surgery is still the first choice and how it should be . When comparing vaginal to laparoscopic routes evidence favors the vaginal approach at the present time standard practice guidelines are based upon the cochrane review which found that as a group laparoscopic hysterectomies took longer to perform and were associated with more bleeding than were vaginal hysterectomies in the cochrane meta analysis laparoscopic hysterectomy took 54 minutes longer than vaginal hysterectomy 95 ci 437 635 a subanalysis of laparoscopic versus . A vaginal hysterectomy was performed through a cir cumferential vaginal incision the anterior cul de sac was easily entered by blunt dissection since the bladder flap had been taken down laparoscopically likewise the pos terior cul de sac was also easily entered and the utero sacral ligaments cardinal ligaments and uterine vessel pedicles were clamped divided and suture ligated using 0 chromic the uterus tubes and ovaries were removed intact the peritoneum was not . Combined laparoscopic and vaginal radical surgery in cervical cancer renaud mc1 plante m roy m author information 1gynecologic oncology service laval university quebec city g1r 2j6 canada mcrenaudsympaticoca objective the purpose of our study was to review our experience with laparoscopic staging and vaginal radical surgery in the treatment of early stage cervical cancer
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