Vaginal hysterectomy

Area of Science:

• Gynecology
• Minimally Invasive Surgery
• Urogynecology

Background:

• Uterine fibroids (myomas) can cause significant gynecological issues, often necessitating hysterectomy.
• Vaginal hysterectomy is a preferred surgical approach due to its minimally invasive nature and faster recovery.
• Managing large or myomatous uteri via vaginal hysterectomy presents unique surgical challenges.

Purpose of the Study:

• To evaluate the feasibility and outcomes of vaginal hysterectomy in patients with significantly enlarged uteri due to myomas.
• To describe surgical techniques employed to manage large myomatous uteri during vaginal hysterectomy.
• To assess the safety and efficacy of this approach in a prospective series.

Main Methods:

• Prospective study of 14 patients undergoing vaginal hysterectomy for myomatous uteri (14-20 weeks' gestation size).
• Surgical techniques included bisection, myomectomy, morcellation, and coring to facilitate uterine removal.
• Procedures were performed with or without bilateral oophorectomy or salpingo-oophorectomy.

Main Results:

• All 14 procedures were completed successfully with no major complications.
• Mean uterine weight was 639g, mean operating time was 84 minutes, and mean blood loss was 296ml.
• Postoperative hospital stay averaged 3.7 days, with all patients fully recovered at follow-up.

Conclusions:

• Vaginal hysterectomy is a safe and effective surgical option for managing enlarged myomatous uteri.
• Specific techniques like bisection and morcellation enable the successful removal of large fibroid uteri via the vaginal route.
• This approach offers favorable outcomes, including short hospital stays and full patient recovery.