Widest Uterine Grip Width Measurement Clinically to Predict the Success of the Vaginal Hysterectomy of a Very Large Fibroid Uterus

Author(s): Ramkrishna Purohit, Jay Gopal Sharma,  Devajani Meher

Objectives:

To find a simple clinical method to predict the success of the vaginal hysterectomy (VH) in the case of a very large fibroid uterus.

Methods:

In an observational study, consecutive cases of hysterectomy for benign large fibroid uterus of 18 to 26 weeks size were included. Preoperatively, the widest uterine grip width was measured clinically by the below-described method. Then, the VH was attempted using the purohit technique.

Results:

A total of thirty-two cases were studied; the widest uterine grip width measured below 15cm in 24 (75%) cases, and it was ≥ 15cm in eight (25%) cases. The attempted VH was successful in 24 (75%) cases associated with the widest uterine grip width ranging between 11 and 14.5cm. The attempted VH failed in four (12.5%) of eight cases with the widest uterine grip width ranging 15-17 cm and needed conversion to abdominal hysterectomy. The vaginal hysterectomy was not feasible due to the inaccessible high-up cervix in the other four (12.5%) of eight cases with grip width ranging from 17-20cm.

Conclusion:

The widest uterine grip width measurement of up to 14.5cm can predict the success of the vaginal hysterectomy in cases of very large uteri of 18 to 26 weeks gestation size.