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Sir,

Thank you for the opportunity of commenting on the article by Garry et al. (Vol 102, April 1995)1, describing their technique of laparoscopically assisted hysterectomy. In the standard technique of vaginal hysterectomy, it is the division of the uterosacral ligaments which is usually the most difficult part. Once this has been achieved, there is marked descent of the cervix and the uterine arteries come into view and can be easily ligated under direct vision. The uterus can then be delivered bringing the fundus down posteriorly in the curve of the sacrum making clamping and ligating the broad ligaments (and possible removal of the ovaries) straightforward. The average length of time for an operation with a surgeon of moderate speed is of the order of forty minutes.

I would therefore advocate that our patients would be better served by encouraging surgeons to use the standard method of vaginal hysterectomy where there is no need for extra instruments and initial expenditure, where there are no abdominal scars and no reason for any difference in the surgical trauma2 and postoperative morbidity so that hospital stay need not be any longer. From the economic point of view, two operations can be completed for the price of one.

Perhaps the good that will come from the present enthusiasm for the use of the laparoscope in achieving a hysterectomy, is that Gynaecologists will learn to appreciate that in the properly selected cases a surgical removal of the uterus by the standard technique is a straightforward and safe operation.

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