Total hysterectomy for a nonprolapsed, benign uterus in women without vaginal deliveries.

Objective: To compare the different techniques of hysterectomy for a nonprolapsed, benign uterus in women without vaginal deliveries.

Study Design: A retrospective study in a university hospital analyzed 148 total hysterectomies in women without vaginal deliveries performed from August 1991 to June 2000. Forty-four patients had had cesarean sections (29.7%), and 104 (70.3%) were nulliparous. Twenty-four patients had had abdominal myomectomies (16.2%). The vaginal route (group 1) was used for 77 patients (52%), 56 (37.8%) had laparotomies (group 2), and 15 (10.2%) had laparoscopically assisted vaginal hysterectomies (group 3).

Results: The uterine weight was 275 (+/- SD 140) g in group 1, 830 (+/- SD 1620) in group 2 and 331 (+/- SD 160) in group 3. Mean operation time was 87 (+/- SD 76) minutes in group 1, 96 (+/- SD 41) in group 2 and 112 (+/- SD 56) in group 3. There was one serious complication with the vaginal route (sigmoid injury). The hospital stay was 4 (+/- SD 3.1) days in group 1, 7.1 (+/- SD 3.8) in group 2 and 4.3 (+/- SD 1.5) in group 3.

Conclusion: Vaginal hysterectomy for a nonprolapsed, benign uterus is indicated for women without vaginal deliveries and is feasible in 72% of cases in our recent experience, with a low complication rate. Training in vaginal surgery should allow safe performance of the procedure at most centers.