Objective: There are many routes to hysterectomy. Despite the obvious higher morbidity, longer hospital stay and a longer recovery; abdominal hysterectomy is the route of choice of hysterectomy world-wide. TLH is gaining popularity but has a significantly high complication rate e.g. bladder, ureter and bowel injuries. It still remains the most expensive route for hysterectomy. VH still remains a feasible option which is cost-effective, with minimal complications. To evaluate the feasibility and complication rate of VH in women with enlarged uteri.

Design: 1400 women underwent VH for benign pathology. Normal contra-indications of vaginal route: moderate-excessive uterine enlargement, nulliparity, previous caesarean section, minimal utero-vaginal descent were challenged.

Setting: VH is the bedrock skill, and signature operation of the Gynaecological Profession- Robert Kovac: Advances in Reconstructive Vaginal Surgery. THE OUTCOME OF ANY SURGERY IS DIRECTLY ASSOCIATED WITH THE SURGEON'S SKILLS.

Patients:

Mean age = 41.5 yrs

Mean parity = 3.2

Nulliparty = 68 (5%)

Multiparity = 1332 (95%)

Previous abdominal surgery = 240 (16.5%)

Minimal uterine descent = 1308 (90%)

Previous caesarean section: 208 (14.8%)

Caesarean section x1 = 122(60.2%)

Caesarean section x2 = 54 (25%)

Caesarean section x3 = 32 (14.8%)

Interventions:

Measurements & Main Results: Total cases = 1400

Abdominal Hysterectomy = 250

Conversion to TAH = 33 (2.4%)

Successful vaginal hysterectomy = 1117 (79.8%)

Duration of stay in hospital (mean) = 2.8 days

Mean weight of uterus = 120 gm

Ave. weight of patient = 77 kg

Complications: Pelvic infection - 16 cases (1.3%); Retro peritoneal haematoma - 11 cases (1.0%); Vault haematoma - 6 cases (0.5%); Ureteric injury - 0 cases (0%); Bladder injury - 8 cases (0.8%); Complications related to: Laparoscopy - 0 cases (0%); Vault abscess - 6 cases (0.5%); Sub-acute bowel obstruction - 1 cases (0.1%)

Conclusions: VH can be performed successfully in women with relative contra-indications and with enlarged uteri. It is significantly cheaper than TLH, with minimal complications. Hence, VH should be the choice operative procedure.