Subtotal vaginal hysterectomy: a new role for an old procedure

Patients with persistent uterine bleeding that is unresponsive to conservative therapy may opt for endometrial ablation over total hysterectomy because of concerns over subsequent sexual dysfunction or other nonclinical issues. Twelve such women with healthy cervices who failed endometrial ablation, and eight candidates for ablation were offered subtotal vaginal hysterectomy as a definitive primary surgical intervention instead of endometrial ablation. Our experience suggests the safety and utility of subtotal vaginal hysterectomy in properly selected patients. Randomized, comparative studies of this technique as an alternative to hysteroscopic ablation or resection may be warranted.