Vaginal removal of the benign nonprolapsed uterus: experience with 300 consecutive operations

To determine the effectiveness and safety of vaginal hysterectomy for benign nonprolapsed uteri.

Three hundred consecutive women with nonprolapsed uteri requiring hysterectomy for benign uterine conditions, without suspected adnexal disease, were treated prospectively by vaginal hysterectomy. Twenty-one women (7%) were nulliparous, and 219 (73%) had history of pelvic surgery (150 had previous cesareans). Operating time, estimated blood loss, surgical techniques (Heaney, Pelosi, uterine morcellation), operative complications, conversion to laparoscopy or laparotomy, and length of hospital stay were recorded for each case.

Vaginal hysterectomy was successful in 297 women (99%). Morcellation (hemisection, intramyometrial coring, myomectomy, and wedge resection) was done in 170 cases (56.7%). The mean operating time was 51 minutes (range 20-130 minutes), mean estimated blood loss was 180 mL (range 50-1050 mL), and mean length of hospitalization was 22 hours (range 16-72 hours). Four operative complications occurred (three cystotomies, one rectal laceration) and were repaired transvaginally. One woman needed a blood transfusion. Eleven urinary tract infections occurred. Two conversions to laparotomy and one conversion to laparoscopy were necessary.

Vaginal hysterectomy is an effective and safe procedure for benign nonprolapsed uteri irrespective of nulliparity, previous pelvic surgery, or uterine enlargement. We question the true need for laparoscopy or laparotomy in this setting.