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Sir,

Dr Rosenberg rightly suggests that laparoscopic-assisted vaginal hysterectomy facilitates the ligation and division of the infudibulopelvic ligaments allowing easier removal of ovaries and fallopian tubes than is possible by the vaginal route. He seems to assume that the women had uterine decent which would facilitate removal of the ovaries by the vaginal route, which was not the case for any of the women in our trial. If the vaginal route had been considered to be the appropriate way of removing the uterus and ovaries, then the woman would have been excluded from the study. Although many surgeons do perform a large number of vaginal hysterectomies, only a minority remove ovaries routinely by this route. Possibly, Dr Rosenberg does find that removing ovaries vaginally in the absence of uterine decent is an easy procedure, but I believe he will be in a minority.