Vaginal hysterectomy for the large uterus

Abstract

Objective To assess the feasibility and safety of performing vaginal hysterectomy on enlarged uteri the equivalent of 14 to 20 weeks of gestation in size. Design A prospective observational study. Setting The Royal Free Hospital, London. Participants Fourteen consecutive women undergoing vaginal hysterectomy for uterine fibroids up to 20 weeks in size. Interventions Vaginal hysterectomy with or without bilateral salpingo‐oophorectomy or oophorectomy. Main outcome measures Uterine size and weight, techniques used to reduce uterine size, surgical outcome, operative time, estimated operative blood loss, intra‐and post‐operative complications, duration of hospitalisation. Results The mean uterine size was 16.3 weeks (range 14 to 20 weeks). All hysterectomies were completed successfully by the vaginal route. The uteri weighed 380 to 1100 g, with a mean of 638.7 g. Bisection combined with myomectomy and morcellation were used in most cases to obtain reduction in uterine size, whereas coring was only utilised in two cases. The mean operating time was 84.3 min with a range of 30 to 150 min. The only complications were transient haematuria (n= 6) and superficial vaginal grazes (n= 5). One of the women required a blood transfusion. The mean post‐operative hospital stay was 3.7 days (range 2 to 9 days). Conclusion Enlargement of the uterus to a size equivalent to 20 weeks of gestation should no longer be considered a contraindication to vaginal hysterectomy. Many more hysterectomies should be carried out vaginally without resorting to abdominal or laparoscopic surgery.

Laparoscopic Assisted Vaginal Hysterectomy: A Case Control Comparative Study with Total Abdominal Hysterectomy

“…A 5mm trocar along with another 10 mm trocar was inserted in the lower abdomen. The stage-IV LAVH 10 began with electrocoagulation and transection of the bilateral round ligaments, the fallopian tubes and ovarian ligaments. Bilateral uterine arteries were identified and the vesico-uterine peritoneum was opened to make the subsequent hysterectomy easier to perform.…”

Randomized comparison of total laparoscopic, laparoscopically assisted vaginal and vaginal hysterectomies for myomatous uteri

“…If the uterine size did not allow easy exteriorization, bisecting, coring, morcellation, enucleation of myomas or combinations of these volume-reducing techniques were performed [21][22][23].…”

Total vaginal hysterectomy (TVH): outcome analysis of 108 cases at a tertiary centre

“…18 Mean operating time was 92.03 min which is comparable to Magos A et al and Kovac et al which showed 84.3 and 94 minutes respectively. 19,2 Mean blood loss was 87.04 ml in our study. Blood loss ranged from 30 ml-160 ml in different studies.…”