Clinical Evaluation of Vaginal Hysterectomy: Safer and Easier Technique for Entering the Anterior Peritoneal Cavity

Abstract

Most gynecologists enter the posterior cul-de-sac in vaginal hysterectomy with nonprolapsed benign uteri, principally, because it is thought that entering the posterior cul-de-sac is anatomically safer and easier than entering the anterior space. However, if it is difficult to enter the posterior cul-de-sac due to pelvic inflammatory disease or endometriosis, vaginal hysterectomy should be abandoned. The present study presents a safer and easier technique for entering the anterior peritoneal cavity for vaginal hysterectomy with nonprolapsed benign uteri. Fifty-one (51) patients who underwent vaginal hysterectomy between 1999 and 2002 were retrospectively reviewed. Uterine weight, duration of the procedures, estimated blood loss, and complications were analyzed. The surgery was completed vaginally in all cases via our procedure. The mean uterine weight was 240.7 ± 166.4 g with a range of 35–1000 g. The mean duration of the procedure was 53.7 ± 16.6 minutes with a range of 27–90 minutes. The mean estimated blood loss was 115.7 ± 87.6 g with a range of 30–389 g. None of the patients required transfusion for blood loss. There were no intraoperative complications, such as injury to the bladder, ureter or bowel, and postoperative complications were limited to febrile morbidity. In our experience, entry into the anterior cul-de-sac in our approach to vaginal hysterectomy is a safe and easy method.