title: How to increase the proportion of hysterectomies performed vaginally.
abstract: OBJECTIVE
  The main purpose of our study was to identify the patient characteristics of women undergoing hysterectomy and to estimate the proportion of hysterectomies that could be done vaginally by recognized surgical techniques.
  
  
  METHODS
  The records of 500 women who underwent hysterectomy were reviewed. The characteristics of patients without an absolute contraindication to vaginal hysterectomy were analyzed.
  
  
  RESULTS
  Overall, 96 (19.2%) of our study group underwent vaginal hysterectomy. A total of 382 (76.4%) women were judged not to have an absolute contraindication to this route. The most frequent characteristics of this group were lack of uterine prolapse (76.4%), a myomatous uterus (44.5%), and a need for oophorectomy (43.2%). We did not exclude women who did not have significant uterine prolapse or a history of pelvic surgery or pelvic tenderness and we included those requiring oophorectomy or with a uterine size up to that of 14 weeks' gestation; with these criteria more than two thirds of the entire study population could undergo vaginal surgery.
  
  
  CONCLUSIONS
  To maximize the proportion of hysterectomies performed vaginally, gynecologists need to be familiar with surgical techniques for dealing with nonprolapsed uteri, uterine leiomyomas, and vaginal oophorectomy.
authors.affiliation: Endoscopy Training Centre, University Department of Obstetrics and Gynaecology, The Royal Free Hospital, London, United Kingdom.
authors.forename: A
authors.initials: A
authors.lastname: Davies
authors.forename: E
authors.initials: E
authors.lastname: Vizza
authors.forename: N
authors.initials: N
authors.lastname: Bournas
authors.forename: H
authors.initials: H
authors.lastname: O'Connor
authors.forename: A
authors.initials: A
authors.lastname: Magos
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000075202:Contraindications; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000379:methods / Q000706:statistics & numerical data*; D007889:Leiomyoma / Q000601:surgery; D008875:Middle Aged; D010052:Ovariectomy / Q000379:methods; D014594:Uterine Neoplasms / Q000601:surgery; D014596:Uterine Prolapse; D014599:Uterus / Q000473:pathology