VAGINAL HYSTERECTOMY WITH AND WITHOUT MORCELLATION - THE UNIVERSITY-OF-NEW-MEXICO HOSPITALS EXPERIENCE

Objective: To compare intraoperative and postoperative complications o f vaginal hysterectomy with and without morcellation. Methods: Between August 1990 and January 1995, 345 women underwent vaginal hysterectom y without laparoscopic assistance at the University of New Mexico and associated hospitals. Medical records available for 340 of these women were reviewed for demographic data, perioperative complications, chan ge in hematocrit, duration of procedure, hospital stay, and uterine si ze and weight. Some of the records were incomplete with respect to ute rine size, uterine weight, and hospital stay. The subjects were divide d into two groups, 281 who had vaginal hysterectomies without morcella tion and 59 who had vaginal hysterectomies with morcellation. The peri operative courses of the two groups were compared. Results: Although w omen undergoing morcellation were significantly older (mean 44 versus 41 years, P = .004), there were no statistically significant differenc es in other surgical or anesthetic risk factors, including parity, obe sity, hormonal status, and preexisting medical disease, Mean uterine w eight was significantly greater in those undergoing morcellation (222 versus 110 g, P < .001). Morcellation significantly increased the dura tion of the procedure (mean 140 versus 168 minutes, P = .004) but did not increase the duration of hospitalization or rate of perioperative complications (18.6 versus 17.4%, odds ratio 1.09, 95% confidence inte rval 0.49-2.35). Conclusion: Uterine morcellation at the time of vagin al hysterectomy is safe and facilitates the vaginal removal of moderat ely enlarged and well-supported uteri without increasing perioperative morbidity.