|March 2006 · Vol. 18, No. 3
Vaginal hysterectomy: Is skill the limiting factor?
For the expert surgeon, there is no absolute uterine size limit
The experts use the vaginal route for more than 90% of hysterectomies
Uteri larger than 1,000 g have been safely removed vaginally
Access to the serosa tends to be greater on the posterior uterus, although the serosa can usually be left intact using morcellation
CPT codes for uteri larger than 250 g carry more relative value units than the codes for smaller uteri, so accurate weight is essential
Professor of Obstetrics and Gynecology, Vanderbilt University School of Medicine,
CASE Bleeding, a large uterus, and no response to hormones
“M.G.,” a 42-year-old nullipara, complains of menstrual periods that last 10 days and occur on a 28-day cycle. She says the bleeding is extremely heavy, with frequent, copious clotting. She routinely avoids planning social activities around the time of her period and occasionally cancels nonessential engagements because of it. Over the past year, this professional woman has missed 6 days of work because of the problem with her menses.