Vaginal hysterectomy with and without morcellation: The University of New Mexico hospital's experience

Objective: To compare intraoperative and postoperative complications of vaginal hysterectomy with and without morcellation. Methods: Between August 1990 and January 1995, 345 women underwent vaginal hysterectomy without laparoscopic assistance at the University of New Mexico and associated hospitals. Medical records available for 340 of these women were reviewed for demographic data, perioperative complications, change in hematocrit, duration of procedure, hospital stay, and uterine size and weight. Some of the records were incomplete with respect to uterine size, uterine weight, and hospital stay. The subjects were divided into two groups, 281 who had vaginal hysterectomies without morcellation and 59 who had vaginal hysterectomies with morcellation. The perioperative courses of the two groups were compared. Results: Although women undergoing morcellation were significantly older (mean 44 versus 41 years, P = .004), there were no statistically significant differences in other surgical or anesthetic risk factors, including parity, obesity, hormonal status, and preexisting medical disease, Mean uterine weight was significantly greater in those undergoing morcellation (222 versus 110 g, P < .001). Morcellation significantly increased the duration of the procedure (mean 140 versus 168 minutes, P = .004) but did not increase the duration of hospitalization or rate of perioperative complications (18.6 versus 17.4%, odds ratio 1.09, 95% confidence interval 0.49-2.35). Conclusion: Uterine morcellation at the time of vaginal hysterectomy is safe and facilitates the vaginal removal of moderately enlarged and well-supported uteri without increasing perioperative morbidity.