Oophorectomy at Time of Vaginal Hysterectomy: A Prospective Study
Drs. William E. Porter, Katherine Haynes, Gary H. Lipscomb, Robert L. Summitt, Jr.
University of Tennessee
Memphis, Tennessee

Objective: To assess the feasibility of removing ovaries at the time of vaginal hysterectomy and to determine predictors of successful outcome.
Materials and Methods: Women scheduled to undergo vaginal hysterectomy and bilateral oophorectomy, with or without additional repairs for prolapse and incontinence, were prospectively enrolled in the study.  Following vaginal hysterectomy, the ovaries were to be removed by a standard clamp technique.  If unsuccessful, endoloops were used to perform the oophorectomy.  If still unsuccessful, an additional staff was called to assist before the oophorectomy was ruleda failure.  Operating times and time for oophorectomies were recorded.  Preoperative demographic factors, prior surgeries and pertinent past historical factors were assessed for associations with successful oophorectomies. Associations with intraoperative findings and postoperative complications were also determined.
Results: Sixty-five patients scheduled for vaginal hysterectomy and bilateral oophorectomy between 1992 and 1997 were enrolled in the study.  In one patient neither ovary was removed secondary to adhesions.  In 3 additional patients only one ovary was removed, 2 due to adhesions and 1 due to hemorrhage.  In 3 (0.5%) oophorectomies requiring additional faculty, the oophorectomy was successful 2 out of  3 times.  The clamp technique was successful 123/130 (94%) ovaries.  Two of the seven failed clamp techniques were successfully completed by the endoloop technique.  Overall 125/130 (96%) ovaries were  successfully removed vaginally.  The mean surgical time for oophorectomy was 17 minutes (range 6 to 55 minutes) and mean overall surgical time was 124 minutes (range 60 to 230 minutes).  Mean decrease in postoperative hemocrit was 6.1% (range 0 to 19.3) and the mean EBL was 448ml (range 100-2300 ml).  Mean uterine weight was 162gm (range 35 to 430 gm).  Eleven out 65 (17%) underwent additional pelvic support procedures.  One patient (0.15%) had a cuff abscess and 2 (0.3%) required a blood transfusion.  No  statistically significant association was found between prior pelvic surgery, history of ectopic pregnancy or pelvic inflammatory disease and the failure to complete oophorectomy. No laparotomies were required in the study population.
Conclusion: Because our study demonstrates such a low failure rate, the need for an oophorectomy is not a contraindication to a vaginal hysterectomy.  Also, there are no predictors of successful or unsuccessful oophorectomy