VAGINAL HYSTERECTOMY BY UTERINE MORCELLATION - AN EFFICIENT, NON-MORBID PROCEDURE

Objective: To evaluate the relationship between uterine size and a pos sible increase in operative morbidity and procedure failure rates in w omen undergoing total vaginal hysterectomy. Methods: A retrospective c hart analysis of all hysterectomies performed for histologically confi rmed leiomyomata was completed. A total of 128 cases qualified. Patien ts were stratified into three groups: group I, patients undergoing vag inal hysterectomy with a uterine weight of 300 g or greater but less t han 1000 g;group II, patients undergoing vaginal hysterectomy with a u terine weight of 100-299 g; and group III, patients undergoing abdomin al hysterectomy with a uterine weight of 100-1000 g. The variables eva luated included the following: length of hospital stay, operative time , estimated blood lass, and operative complications. Data regarding fa iled vaginal hysterectomy requiring an abdominal approach were also ob tained. Results: Both vaginal hysterectomy groups had a significantly reduced length of stay compared with the total abdominal hysterectomy group. There was no significant difference in mean estimated blood los s between groups I and III. Similarly, there were no significant diffe rences in complication rates among the three groups. Group I had an 84 % (31 of 37) success rate versus 95% (40 of 42) for group II (not stat istically significant). There were no significant differences in the m ean uterine weight, estimated blood loss, and complication rate in uns uccessful versus successful vaginal hysterectomies. The estimated bloo d loss was significantly higher for unsuccessful vaginal hysterectomy. Conclusion: Uterine size alone is not an absolute contraindication to vaginal hysterectomy. Large uterine size (greater than 300 g) was not related to a significant increase in failed vaginal hysterectomy. Con versely, failed vaginal hysterectomy was not size-dependent. Furthermo re, there is no additional operative morbidity when vaginal hysterecto my is converted to a total abdominal hysterectomy because of a technic al inability to complete the surgery vaginally.