THE FEASIBILITY OF PERFORMING HYSTERECTOMIES VAGINALLY IN THE ABSENCE OF UTERO-VAGINAL PROLAPSE. A PROSPECTIVE STUDY OF A SIMPLE STRATEGY.

Abstract
To investigate if just a decision to increase the rate of vaginal hysterectomies can be effective in increasing the proportion of hysterectomies carried out vaginally for benign conditions in the absence of prolapse. In the five-year period 272 hysterectomies out of 553 were eligible for the study. Patients with prolapse, adenexal disease, fibroids >16 weeks and malignancy were excluded. The proportion of vaginal hysterectomies increased from 32% in the first year to 95 % in the final year of the study. In the fifth year of study the majority of associated oophorectomies were also performed vaginally. There was no increase in patient morbidity and conversion to abdominal hysterectomy was needed in only two cases. The decision regarding the route of hysterectomy should be made intraoperatively. A willingness and resolve to change practice is all that is needed to increase the proportion of hysterectomies carried out by the vaginal route. There is no need for extra training, special skills or complicated equipment. Therefore, the major determinant of the route of hysterectomy is not the clinical situation but the attitude of the surgeon. This simple strategy could result in significant reduction in the cost of hysterectomies without any increase in patient morbidity.

Key words
Vaginal hysterectomy, dysfunctional bleeding, non-prolapsed uterus, technique.

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