The route for hysterectomy: is it time to change?

Objective To determine the proportion of hysterectomies done by the vaginal route for all benign gynaecological indications, at our centre, and to assess our performance with respect to the feasibility of bilateral salpingo-oöphorectomy, and also to identify any major complications.

Design A retrospective analysis of case notes on 99 consecutive hysterectomies done for benign gynaecological indications.

Setting A district general hospital.

Results Out of 99 hysterectomies, 92 were done by the vaginal route, (excluding four laparoscopy-assisted vaginal hysterectomies), with no significant major complications except for one conversion to laparotomy. Bilateral salpingo-oöphorectomy was successfully performed in 98.3% of patients in whom it was planned. There was no significant uterine prolapse in 78% of patients undergoing vaginal hysterectomy, and the largest uterus removed vaginally weighed 1146 g.

Conclusions Vaginal hysterectomy is feasible in most patients with benign gynaecological indications. Where possible contraindications exist, the use of preliminary laparoscopy should be encouraged, to help in the proper selection of patients and perhaps to remedy any relative contraindications. Gynaecologists need to appraise the vaginal route, and there is a strong need to address training issues as far as vaginal surgery is concerned.