Vaginal route as the norm when planning hysterectomy for benign conditions: change in practice

To investigate if a deliberate decision to carry out as many hysterectomies as possible by the vaginal route can be effective in increasing the proportion of vaginal hysterectomies for benign conditions in the absence of prolapse.

Practice over 5 years at a district general hospital in the United Kingdom was studied. Patients with prolapse, adnexal disease, leiomyoma larger than 16 weeks, and malignancy were excluded, leaving 272 hysterectomies of 553 originally. Change in the route of hysterectomy, the main endpoint, was observed at yearly intervals.

At the start of the study, the route of surgery was 68% abdominal and 32% vaginal. By the end of the fifth year the pattern was 5% abdominal 95% vaginal. The conversion from vaginal to abdominal hysterectomy occurred in only two cases during the study period. There was no change in the case mix during this period. In the fifth year of study most associated oophorectomies were also performed vaginally. There was no increase in patient morbidity.

A major determinant of the route of hysterectomy is not the clinical situation but the attitude of the surgeon. There is no need for extra training and special skills or complicated equipment for vaginal hysterectomy.