Vaginal hysterectomy for enlarged uteri, with or without laparoscopic assistance: randomized study

Objective: To compare short-term results of vaginal hysterectomy (VH) with those of laparoscopically assisted vaginal hysterectomy (LAVH) in women with enlarged uteri. Methods: Eighty women referred for abdominal hysterectomies for benign disease were assigned randomly to vaginal hysterectomy or LAVH. Inclusion criteria were uterine size larger than 280 g and one or more of the following traditional contraindications of vaginal hysterectomy: previous pelvic surgery, history of pelvic inflammatory disease, moderate or severe endometriosis, concomitant adnexal masses, indication for adnexectomy, and nulliparity without uterine descent. Results: There were no differences in patients’ mean age, parity, rate of postmenopausal state, previous pelvic surgery, preoperative hemoglobin levels, and mean uterine weight. Indications for surgery were similar between groups. No difference was found in the mean ± standard deviation (SD) uterine weight (range) between vaginal hysterectomy and LAVH groups (424 ± 211 g [280–930 g] and 513 ± 360 g [290–1560 g]), respectively. Except for one bladder injury in the laparoscopic group (injury treated laparoscopically), there were no other major complications. Complication rates in vaginal and laparoscopic groups were 15% and 37.5%, respectively (P < .05). Mean operating time was shorter in the vaginal than the laparoscopic group (108 ± 35 minutes and 156 ± 50 minutes, respectively [P < .001]). There was no difference in first day hemoglobin level drops or hospital stays between groups. Conclusion: Vaginal hysterectomy can be successful even in women with enlarged uteri and other conditions considered by some to contraindicate the operation. Laparoscopically assisted vaginal hysterectomy offered no advantages over the standard vaginal hysterectomy.