The success of the first series of patients using this protocol prompted the author to utilize and refine this protocol almost entirely in his practice. While it is true that the actual surgical technique of the vaginal hysterectomy may be of paramount importance in this protocol, it is only one of four similarly important links in the chain. The other three are patient motivation, appropriate anesthesia and excellent post-operative nursing care. It is beyond the scope of this paper to detail many of the minor points of the surgical technique used by the author. Patients are individually selected and counseled regarding this protocol.
Patient motivation is evaluated at the time of pre-operative counseling.
The patients are counseled as to the post-operative pain management and activity, not only by the author but also by the office and hospital staff. It is beyond the province of the surgeon to administer the anesthetic to the patients. The professional interplay between the surgeon and the anesthesia department is important in the choice of agents during and after the surgical procedure. Consistency with the administration of anesthesia was achieved with collegial interaction. The management of post-operative pain required the close cooperation of the surgeon and the nurses responsible for supervising pain management.