HOW TO INCREASE THE PROPORTION OF HYSTERECTOMIES PERFORMED VAGINALLY

OBJECTIVES: The main purpose of our study was to identify the patient characteristics of women undergoing hysterectomy and to estimate the p roportion of hysterectomies that could be done vaginally by recognized surgical techniques. STUDY DESIGN: The records of 500 women who under went hysterectomy were reviewed. The characteristics of patients witho ut an absolute contraindication to vaginal hysterectomy were analyzed. RESULTS: Overall, 96 (19.2%) of our study group underwent vaginal hys terectomy A total of 382 (76.4%) women were judged not to have an abso lute contraindication to this route. The most frequent characteristics of this group were lack of uterine prolapse (70.4%), a myomatous uter us (44.5%), and a need for oophorectomy (43.2%). We did not exclude wo men who did not have significant uterine prolapse or a history of pelv ic surgery or pelvic tenderness and we included those requiring oophor ectomy or with a uterine size up to that of 14 weeks' gestation; with these criteria more than two thirds of the entire study population cou ld undergo vaginal surgery. CONCLUSIONS: To maximize the proportion of hysterectomies performed vaginally, gynecologists need to be familiar with surgical techniques for dealing with nonprolapsed uteri, uterine leiomyomas, and vaginal oophorectomy.