[Clinical study on transvaginal hysterectomy for moderate enlarged uterus]

To assess the feasibility and safety of performing transvaginal hysterectomy(TVH) on moderate enlarged uteri.

Twenty-five transvaginal hysterectomies were performed on enlarged myomatous uteri, with the size equivalent to 12-17 gestational week or 280-570 g. Bisection, enucleation, morcellation and combinations thereof were used to facilitate the operation by reducing the uterine volume. The operation time, blood loss, morbidity as well as complications were observed and analyzed.

Twenty-two out of 25 vaginal hysterectomies were successfully completed with a success rate of 88%. Another 3 cases were converted to transabdominal hysterectomies, 2 of them were due to technical difficulties. One bladder injury and one severe intraoperative hemorrhage occurred. Two cases required blood transfusion. The mean operating time was (119 +/- 32) min. The mean blood loss was (231 +/- 107) ml with a range of 100-500 ml except the case with severe hemorrhage. The morbidity rate was as low as 4% and the average postoperative hospital stay was (5.5 +/- 1.1) days. The follow-up at 2-48 months after operation showed excellent recovery in all cases without any late postoperative complications.

In the hands of experienced vaginal operation surgeons some of the enlarged uteri(> or = 12 weeks gestational size, i.e. > or = 280 g) with benign disease can be safely removed transvaginally through reduction of uterine volume if the uterus is mobile and obtaind more satisfactory recovery.