Preoperative Sonographic Estimation of Uterine Volume: An Aid to Determine the Route of Hysterectomy

The objective of this study was to establish and estimate uterine volumes, by ultrasonography (USG), as a preoperative aid to determine the vaginal route for hysterectomy (VH). A preoperative sonographic estimation of the uterine volume was carried out in 380 nonpregnant women with nonmalignant mobile uteri of up to 18-20 weeks' size scheduled for VH. No difficulties were encountered in the surgery where the uterine volume was below 200 cm³. For volumes above 400 cm³, debulking was required in all cases. Vaginal hysterectomy failed in four cases with preoperative uterine volumes of 500-700 cm³. For volumes larger than 300 cm³, greater skill is required to accomplish vaginal hysterectomy, and VH should be considered on a trial basis, particularly when the volume exceeds 400 cm³. The option of laparoscopic assistance and laparotomy should be kept as a standby. This conclusion was later applied to a prospective study of 112 women who underwent vaginal hysterectomy without surgical failure or recourse to laparoscopy or laparotomy.