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  • Title: Abdominal hysterectomy versus transvaginal morcellation for the removal of enlarged uteri.
    Author: Hoffman MS, DeCesare S, Kalter C.
    Journal: Am J Obstet Gynecol; 1994 Aug; 171(2):309-13; discussion 313-5. PubMed ID: 8059807.
    Abstract:
    OBJECTIVE: The purpose of this study was to compare the intraoperative and postoperative complications of transvaginal morcellation and abdominal hysterectomy for the removal of moderately enlarged uteri. STUDY DESIGN: An observational study was performed on all uteri weighing > 200 gm removed transvaginally from July 1, 1987, to June 30, 1993. An abdominal hysterectomy control group was selected. RESULTS: There were 50 patients in the vaginal group and 112 in the abdominal group. At a p value < 0.05 there was no statistically significant difference between the two groups for age, parity, obesity, hypertension, insulin-dependent diabetes mellitus, or prior genitourinary surgery. The mean operative time in the vaginal hysterectomy group was 122 minutes and in the abdominal hysterectomy group 148 minutes (p < 0.05). The mean estimated blood loss was 527 and 586 ml, respectively (not significant). Twenty-two percent of the vaginal group and 70% of the abdominal group underwent bilateral oophorectomy (p < 0.05). The mean uterine weights were 335 and 336 gm, respectively (not significant). The mean day of starting a regular diet was 2.1 and 3.6, respectively (p < 0.05). The mean day of discharge was 3.6 and 5.1, respectively (p < 0.05). Complications were similar for the two groups. CONCLUSIONS: In selected patients transvaginal morcellation is a safe and effective alternative to abdominal hysterectomy for the removal of moderately enlarged uteri. The two procedures are comparable in operative time, blood loss, and complications. Both ovaries are more likely to be removed with abdominal hysterectomy. Cosmesis and recuperation may be advantages of the vaginal approach. Obstetrician-gynecologists compared data on 50 women who underwent vaginal hysterectomy with piecemeal removal of uterine segments (transvaginal morcellation) between July, 1987, and June, 1993, with data on 112 age-, uterine weight-, and concomitant medical problem-matched women who underwent abdominal surgery for uterine leiomyomas between 1986 and 1992. The 2 groups were similar for parity, obesity, hypertension, insulin-dependent diabetes mellitus, and prior genitourinary surgery. The mean time needed to perform the vaginal approach was significantly shorter than the abdominal approach (122 vs. 148 minutes; p .05). Bilateral ovariectomy was concurrently performed about 4 times more often in abdominal hysterectomy controls than in vaginal hysterectomy cases (70% vs. 18%; p .05). Even though controls had more blood loss than cases (586 vs. 527 ml) and were more likely to need a blood transfusion (19% vs. 6%), the difference was not significant. As uterine weight increased, so did the operative time and estimated blood loss (p .05). Vaginal hysterectomy cases returned to a regular diet earlier than did abdominal hysterectomy controls (2.1 vs. 3.6 days; p .001). They also were discharged earlier than controls (3.6 vs. 5.1 days; p .001). Complications were similar for both groups (e.g., soft tissue infection, 10% for vaginal and 12% for abdominal). Transvaginal morcellation may be the best hysterectomy approach for the obese, women who are severely medically compromised, or women with concurrent pelvic relaxation defects. These findings show that transvaginal morcellation is a safe and effective alternative to abdominal hysterectomy.
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