Vaginal hysterectomy for enlarged uteri, with or without laparoscopic assistance: Randomized study

Objective: To compare short-term results of vaginal hysterectomy (VH) with those of laparoscopically assisted vaginal hysterectomy (LAVH) in women wit h enlarged uteri. Methods: Eighty women referred for abdominal hysterectomies for benign dise ase were assigned randomly to vaginal hysterectomy or LAVH. Inclusion crite ria were uterine size larger than 280 g and one or more of the following tr aditional contraindications of vaginal hysterectomy: previous pelvic surger y, history of pelvic inflammatory disease, moderate or severe endometriosis , concomitant adnexal masses, indication for adnexectomy, and nulliparity w ithout uterine descent. Results: There were no differences in patients' mean age, parity, rate of p ostmenopausal state, previous pelvic surgery, preoperative hemoglobin level s, and mean uterine weight. Indications for surgery were similar between gr oups. No difference was found in the mean +/- standard deviation (SD) uteri ne weight (range) between vaginal hysterectomy and LAVH groups (424 +/- 211 g [280-930 g] and 513 +/- 360 g [290-1560 g]), respectively. Except for on e bladder injury in the laparoscopic group (injury treated laparoscopically ), there were no other major complications. Complication rates in vaginal a nd laparoscopic groups were 15% and 37.5%, respectively (P <.05). Mean oper ating time was shorter in the vaginal than the laparoscopic group (108 +/- 35 minutes and 156 +/- 50 minutes, respectively [P <.001]). There was no di fference in first day hemoglobin level drops or hospital stays between grou ps. Conclusion: Vaginal hysterectomy can be successful even in women with enlar ged uteri and other conditions considered by some to contraindicate the ope ration. Laparoscopically assisted vaginal hysterectomy offered no advantage s over the standard vaginal hysterectomy. (Obstet Gynecol 2001;97:712-6. (C ) 2001 by The American College of Obstetricians and Gynecologists.).