Vaginal Removal of the Benign Nonprolapsed Uterus: Experience With 300 Consecutive Operations

Abstract

Vaginal hysterectomy offers advantages over an abdominal approach; but, because it is considered difficult or dangerous in many women, it is used for only one fourth of all hysterectomies. This article reports on a series of 300 consecutive women who underwent vaginal hysterectomy for benign gynecological conditions. To be eligible, patients had to have no vaginal prolapse, suspected adnexal disease, or suspected cancer.

Vaginal hysterectomies were done using the classic Heaney technique or the Pelosi technique, which involves cutting the uterosacral and cardinal ligaments after injection of a dilute solution for hemostasis. Morcellation was required in 56.7 percent of cases (Figs. 1 and 2).

The majority of the women were obese, with a mean body mass index of 27 kg/m2 (69 >30 kg/m2), and had a history of previous pelvic surgery (73 percent, of which 50 percent were cesarean section). Mean parity was 3.1, mean age was 46 years, and 7 percent were nulliparous.

Mean operating time was 51 minutes (range, 20–130 min), and patients were discharged after an average of 22 hours (range, 16–720 hours; 12 patients). Average estimated blood loss was 180 ml (range, 50–1050 ml), and one blood transfusion was required. The Pelosi technique was used in 40 cases, the Heaney technique in 260, and morcellation was performed in 170 cases. Forty women underwent bilateral oophorectomy at the time of the hysterectomy. The mean uterine weight was 186 gm (range, 30–1160 gm). No patient had a malignancy.

There were three intraoperative complications. In two instances, the bladder was sharply perforated, and in one, the anterior rectal wall was perforated. All were successfully repaired transvaginally. The only postoperative complications were 11 urinary tract infections. Only three (1 percent) of the 300 vaginal operations had to be converted to abdominal procedures. In two patients, hemostasis at the level of infundibulopelvic ligaments could not be controlled and laparotomy was required, and one laparoscopy was performed to remove an endometriotic ovary.

Obstet Gynecol 1999;94:348–351