Vaginal hysterectomy for the large uterus

Area of Science:

• Gynecology
• Minimally Invasive Surgery

Background:

• Uterine fibroids commonly cause abnormal uterine bleeding and pelvic pressure.
• Enlarged uteri have traditionally been considered a contraindication for vaginal hysterectomy.

Purpose of the Study:

• To evaluate the feasibility and safety of vaginal hysterectomy for uteri enlarged to 14-20 weeks of gestation.
• To determine if uterine size is a contraindication for vaginal hysterectomy.

Main Methods:

• Prospective observational study at The Royal Free Hospital, London.
• Included fourteen women undergoing vaginal hysterectomy for uterine fibroids (14-20 weeks size).
• Procedures included vaginal hysterectomy with or without adnexectomy; uterine size reduction techniques were employed.

Main Results:

• All fourteen vaginal hysterectomies were completed successfully on uteri measuring 14-20 weeks (mean 16.3 weeks, 380-1100g).
• Mean operative time was 84.3 minutes; bisection with morcellation was the primary size reduction technique.
• Complications were minimal (transient hematuria, vaginal grazes); one patient required transfusion. Mean hospital stay was 3.7 days.

Conclusions:

• Uterine size up to 20 weeks of gestation is not a contraindication for vaginal hysterectomy.
• Vaginal hysterectomy should be considered more frequently, potentially reducing the need for abdominal or laparoscopic approaches.