Bilateral Salpingo-Oophorectomy During Vaginal Hysterectomy in Cases with Nonprolapsed Uterus: Role of Laparoscopy in a Residency Training Program Without Much Vaginal Salpingo-Oophorectomy Experience

Abstract

We developed a laparoscopic-assisted vaginal salpingo-oophorectomy technique that increases the rate of successful bilateral salpingo-oophorectomy during vaginal hysterectomy. Our purpose was to determine whether this technique increases the rate of vaginal hysterectomy and bilateral salpingo-oophorectomy in a residency training program that does not have much experience with vaginal salpingo-oophorectomy in nonprolapsed uteri. Thirty-four (34) consecutive women with nonprolapsed uteri requiring hysterectomy and bilateral salpingo-oophorectomy were treated with vaginal hysterectomy and bilateral salpingo-oophorectomy. All patients underwent an initial diagnostic laparoscopy. Six (6) women (17.6%) had minimal periovarian adhesions that lysed laparoscopically. Residents' perception of their surgical skills in vaginal hysterectomy were evaluated before and after the surgeries using the five-point Likert scale. The goals were total vaginal hysterectomy, bilateral vaginal salpingo-oophorectomy, and laparoscopic-assisted vaginal salpingo-oophorectomy if vaginal access to adnexa was not possible. Senior residents performed all surgical tasks. Vaginal hysterectomy was successful in all women. Of 34 women, 12 (35.3%) had laparoscopic-assisted vaginal removal of the adnexa, 7 had unilateral, and 5 had bilateral laparoscopic-assisted salpingo-oophorectomy. There were no differences between the vaginal and laparoscopic-assisted salpingo-oophorectomy groups except the duration of salpingo-oophorectomies (15.9 versus 27.6 minutes, p < 0.001). Mean operating time, uterine weight, blood loss, and mean length of hospital stay were the same in both groups. Residents' perceptions of their surgical skills in performing vaginal hysterectomy were improved after the operations. Overall, performing vaginal hysterectomy in nonprolapsed uteri increased the total number of vaginal hysterectomies done by the senior residents by a factor of 3.04. Total vaginal hysterectomy is possible in nonprolapsed uteri. Laparoscopy enables the surgeon to observe the pelvic viscera before and after the vaginal hysterectomy to rule out ovarian pathology and any bleeding from the vaginal vault and pedicles, and, in difficult cases, serves as a portal for salpingo-oophorectomy.