Vaginal hysterectomy

In spite of being an eminent procedure in the repertoire of gynaecological practice there is no consensus on the best way of performing a hysterectomy in any particular clinical situation. Vaginal hysterectomy (VH) is associated with lower morbidity; fewer complications; shorter hospital stay and convalescence in comparison to abdominal hysterectomy (AH). VH is also more cost effective in comparison to laparoscopically assisted vaginal hysterectomy (LAVH) as the latter is expensive in terms of operating time and cost of equipment. It should not follow, therefore, that less than one-third of all hysterectomies are being performed vaginally.

There are two main factors influencing the type of surgery offered to the patient, namely the patient characteristics and the experience and preference of individual surgeons. Patient characteristics such as nulliparity and the large fibroid uterus serve as relative contraindications to vaginal surgery and hence the more inexperienced surgeon would traditionally opt for the abdominal approach. Special procedures have been suggested, however, which enable VH to be successfully performed in these patients. By educating the surgeon and encouraging the implementation of these techniques, the rates of VH can be maximised in order to provide the most optimal and cost effective service to women.