A prospective study to evaluate oophorectomy at the time of vaginal hysterectomy

Objective To assess the feasibility and safety of vaginal removal of ovaries at the time of vaginal hysterectomy. Design Prospective study. Setting London teaching hospital. Population Between March 1993 and March 1995, 40 women were admitted under the care of one consultant for vaginal hysterectomy and bilateral oophorectomy. Methods The success rate of removing the ovaries vaginally was calculated and the operative time, blood loss, intra- and post-operative complications and patient recovery were analysed and compared with 48 patients who had a vaginal hysterectomy but retained their ovaries during the same time period. Results Thirty-nine (97.5%) of the 40 women due to undergo removal of the ovaries were managed successfully via the vaginal route; one woman required laparoscopic removal of one of her ovaries containing an ovarian cyst which was not diagnosed pre-operatively. A variety of techniques were used for vaginal oophorectomy which included salpingo-oophorectomy, oophorectomy without salpingectomy, and transvaginal endoscopic oophorectomy utilising endoloop sutures or bipolar electrosurgery. Oophorectomy added a mean of 23.4 min (88.3 vs 64.9 min, 95% CI 10.2-36.7, P < 0.001) to the total operating time compared with vaginal hysterectomy alone. No laparotomies were required, and both the complication rate and post-operative inpatient stay were similar for the two groups. Conclusion The need to perform oophorectomy should not be considered a contraindication to vaginal hysterectomy.