[Modified approach to difficult vaginal hysterectomy]

To explore the advantage, feasibility and safety of modified approach to difficult vaginal hysterectomy and provide scientific rationales for expanding its indications.

A retrospective study was conducted for 237 patients undergoing hysterectomy for benign disease of uterus (without prolapse) from January 2009 to July 2012. Both modified approach to difficult vaginal hysterectomy (TVH, n = 167) and abdominal hysterectomy (TAH, n = 70) were performed. Two groups were compared for epidemiological, clinical characteristics, operative duration, intraoperative blood loss volume, perioperative and postoperative complications, hospitalization duration, inflammatory response and follow-up outcomes. TVH was divided into 3 subgroups of enlarged uterus (n = 100), prior pelvic surgeries/endometriosis history (n = 25) and complicated cases with multiple factors (n = 42). Then the surgical outcome parameters were compared for each group.

The operative duration, intraoperative blood loss volume and blood transfusion amount were significantly less in the TVH group than those in the TAH group (P < 0.05). No major perioperative complications occurred in either group. There was no conversion from TVH into TAH. Inflammatory response, gastrointestinal recovery and hospitalization duration for the TVH group were significantly shorter than those of the TAH group (P < 0.05). The hospitalization expense was almost the same in two groups (P > 0.05). Postoperative complications and the quality of sexual health were not statistically different between two groups at 1 month and 6 months post-operation (P > 0.05). The data of three TVH subgroups were collected. The complicated cases with multiple factors group had longer hospitalization duration than the enlarged uterus and the prior pelvic surgeries/endometriosis history groups (P < 0.05). Similarly the volume of blood loss in the complicated cases with multiple factors group was significantly more than those of other two groups (P < 0.05).

As one kind of mini-invasive surgery with less complications, higher safety and feasibility, modified approach to difficult vaginal hysterectomy offers shorter operative duration, less volume of blood loss and faster recovery.