Vaginal Hysterectomy for the Enlarged Fibroid Uterus: A Report of 85 Cases

Abstract Objective To demonstrate that increased uterine size should not be a deterrent to the vaginal approach for performing hysterectomy. Method We performed a retrospective study of the medical records pertaining to 2769 hysterectomies performed by a single surgeon. For this study, we reviewed the surgical details and outcome of 85 women who had a vaginal hysterectomy for a symptomatic fibroid uterus that was estimated to be equivalent in size to a uterus of between 10 and 20 weeks' gestation. Results The vaginal approach for hysterectomy was successful in all 85 cases and complication rates were low. Sixteen women had additional adnexal surgery besides hysterectomy. In 52 cases, morcellation of the uterus was required. Average operating time was 60 minutes. Conclusion Increased uterine size should not be an automatic deterrent to the vaginal approach for hysterectomy. Nevertheless, individual surgeons should perform such challenging procedures only if they are properly trained and are comfortable doing so. Some surgeons may choose not to perform hysterectomies using the vaginal approach