Abstract
We describe a modification to the traditional method of bilateral salpingo-oophorectomy during vaginal hysterectomy. The uterus is bivalved and the hemiuterus is rotated laterally, allowing access to the adnexa. A clamp is then placed across the infundibulopelvic ligament under direct visualization, without first ligating the utero-ovarian ligament, facilitating the simultaneous removal of the hemiuterus, ipsilateral fallopian tube, and ovary. This procedure was performed on eight consecutive patients between July 2003 and May 2004, and outcomes were compared to those in 13 consecutive patients who had vaginal hysterectomies during the same time period. All procedures were performed by either a second- or thirdyear resident in obstetrics and gynecology with at least one of the coauthors providing assistance. There were no significant differences between the two groups by univariate analysis with respect to age, number of previous vaginal deliveries, weight, estimated blood loss, or postoperative complications. There was a signifiant decrease in operative time in the group that underwent vaginal hysterectomy and bilateral salpingo-oophorectomy compared to vaginal hysterectomy alone (53.9 ± 5.8 minutes versus 87.7±7.2, p = 0.004). The group that underwent vaginal hysterectomy alone also had significantly larger uteri (p = 0.03). On multivariate analysis, only uterine weight was significantly correlated with operative time and blood loss. Bilateral salpingo-oophorectomy at the time of vaginal hysterectomy was not independently associated with operative time or blood loss. (J GYNECOL SURG 21:9)
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