***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: One hundred and twelve vaginal hysterectomies were perormed over a 2.8-year period . Five different techniques ofcuff closure were performed , and evaluated for their preservation of vaginal depth . We have concluded that all five methods are acceptable ways to close the vaginal cuff at the time of transvaginal hysterectomy as long as there is proper vault support . Each surgical closure is pictorially illustrated . Morbidity was minimal , and vaginal dcpth was retained The commonest complication associated with  vaginal hysterectomy  is vault hematoma ( 1 ) , which has been detected by ultrasound in 34–59 % cases postoperatively ( 1,2 ) . This has been shown to increase febrile morbidity , need for blood transfusions , longer hospital stay , and higher readmission rate ( 2 ) . We therefore design ed a r and omized , controlled trial to determine whether nonclosure of the vaginal vault reduced the risk of febrile morbidity Fifty premenopausal patients requiring hysterectomy as treatment for symptomatic uterine leiomyomas , which were the size of 14 to 18 weeks ' gestation , were r and omized into two groups to determine whether preoperative gonadotropin-releasing hormone agonist would increase the feasibility of vaginal rather than abdominal hysterectomy . The control group ( group A ; n = 25 ) did not receive preoperative gonadotropin-releasing hormone agonist , but patients in Group B ( n = 25 ) received 2 months of gonadotropin-releasing hormone agonist before undergoing hysterectomy . Patients in the two groups were similar with respect to age , gravidity , parity , pretreatment uterine size , and hemoglobin and hematocrit levels . Patients in group B had an increase in hemoglobin levels ( 10.75 to 12.12 gm/dl , p less than 0.05 ) and a decrease in uterine volume ( 1086.7 to 723.4 ml , p less than 0.05 ) after 8 weeks of agonist therapy and were more likely to undergo vaginal hysterectomy ( 76.0 % vs 16 % ) . Patients in group B also had shorter hospitalizations ( 5.2 vs 3.8 days , p less than 0.05 ) . We conclude that the administration of gonadotropin-releasing hormone agonist for 2 months followed by vaginal hysterectomy is preferable to abdominal hysterectomy in selected patients with uterine leiomyomas OBJECTIVE : To compare blood loss , operative time , postoperative pain medication requirements , and complication rates in patients undergoing vaginal hysterectomy who were r and omly assigned to receive preoperative intracervical vasopressin or no intracervical injection . METHODS : Fifty-eight women undergoing vaginal hysterectomy were r and omly allocated to receive either eight units of vasopressin intracervically or nothing preoperative from January 2004 to January 2005 . A research er blinded to the study group determined blood loss . The surgeries were performed using uniform steps by senior residents under the direction of two attending surgeons . Multiple preoperative and postoperative values were evaluated , including time to specific points in surgery and use of postoperative pain medication . Independent sample t tests , Fisher exact test , and Pearson & khgr;2 tests were used to analyze the data . RESULTS : The two groups were similar in terms of age , weight , parity , and ethnicity . There was also no difference in indication for surgery or estimated uterine size . The vasopressin group lost significantly less blood ( 145.3 mL compared with 266.4 mL control ; P=.022 ) . There was a significant difference in the increase in mean blood pressure at 5 minutes after injection ( 10.4 for the vasopressin group compared with . 2.5 for the control group , P=.043 ) . There was no significant difference in immediate recovery room morphine requirements , but patient-controlled anesthesia usage was significantly higher in the vasopressin group . CONCLUSION : The preoperative injection of intracervical vasopressin leads to decreased blood loss during vaginal hysterectomy . There was , however , a significant increase in postoperative morphine use in patients receiving vasopressin . CLINICAL TRIAL REGISTRATION : Clinical Trials.gov , www . clinical trials.gov , NCT00799292 LEVEL OF EVIDENCE : Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVE This study was undertaken to compare the use of bipolar vessel sealing system ( BVSS ) with conventional suture ligature in  vaginal hysterectomy ( VH ) on a non-prolapsed uterus . STUDY DESIGN Women referred for VH for uterine myoma were r and omized to BVSS ( n=45 ) or conventional suture ligature VH ( n=45 ) . Exclusion criteria were uterine prolapse and indication associated surgical procedures . Main outcome measures were operative time , blood loss , hospital stay , pain status , peri and post-operative complications . Data of patients were collected prospect ively . Statistical analysis was performed using chi-square and Student 's t-test as appropriate . RESULTS There were no differences in patients ' mean age , parity and uterine size between groups . Patients in the BVSS group had a significantly reduced operating time ( 29.2+/-2.1 min vs. 75.2+/-5 min ; p<0.001 ) , operative blood loss ( 84+/-5.9 mL vs. 136.4+/-89.1 mL ; p=0.001 ) , requirement of surgical sutures ( 1.2+/-0.6 units vs. 7.4+/-0.3 units ; p<0.001 ) , pain status ( 1.6+/-0.4 vs. 3.6+/-0.4 ; p<0.001 ) and hospital stay ( 25.6+/-0.9h vs. 33.2+/-1.7h ; p<0.001 ) compared to the control group . The overall complication rate in the study was 7.8 % ( 7/90 ) , and did not differ between patients of the BVSS and control group . CONCLUSION Bipolar vessel sealing for vaginal hysterectomy appears to be an effective and safe haemostatic control method , with reduced operating time , peri-operative blood losses , post-operative pain and hospital stay OBJECTIVE This study compared 3 surgical methods of prophylaxis against enterocele formation employed at the time of vaginal hysterectomy . STUDY DESIGN One hundred consecutive women undergoing total vaginal hysterectomy for various reasons were r and omly assigned to have 1 of 3 surgical methods applied to the posterior superior aspect of the vagina for prophylaxis against enterocele formation . The first procedure involved closing the cul-de-sac and bringing the uterosacral-cardinal complex together in the midline in a vaginal Moschcowitz-type operation . The second procedure was a McCall-type culdeplasty to obliterate the cul-de-sac , plicate the uterosacral-cardinal complex , and elevate any redundant posterior vaginal apex . The third technique used only the peritoneum to close the cul-de-sac , allowing passive movement of the uterosacral-cardinal complex to the midline , no obliteration per se , and no elevation of the posterior vagina . Postoperative findings on pelvic examination were evaluated at 6 weeks , 3 months , and 1 , 2 , and 3 years . Statistical analysis was performed with the chi2 test of independence . RESULTS At 6 weeks ' follow-up and at 3 months ' follow-up there were no prolapses involving the posterior superior segment of the vagina . At 1 year of follow-up 11 patients had stage 1 or 2 posterior superior segment prolapse . At 2 years ' follow-up this number was 16 . At 3 years ' follow-up the McCall-type method was statistically better ( chi2 = 11.27 with 2 degrees of freedom , P = . 004 ) than the other 2 in preventing postoperative enterocele ( n = 2 of 32 with McCall-type procedure , n = 10 of 33 with vaginal Moschcowitz-type procedure , and n = 13 of 33 with peritoneal closure only ) . CONCLUSION When applied at the time of vaginal hysterectomy the McCall-type culdeplasty is superior to a vaginal Moschcowitz-type procedure and to simple peritoneal closure in preventing subsequent enterocele OBJECTIVE The purpose of this study was to compare the efficacy of chlorhexidine and povidone iodine for cleansing the operative field for vaginal surgery . STUDY DESIGN This was a r and omized controlled trial that compared 10 % povidone iodine and 4 % chlorhexidine gluconate as surgical scrubs . Our primary end point was the proportion of contaminated specimens ( defined as total bacterial colony counts of > /=5000 colony-forming units ) per group found throughout the surgical procedures . All patients received st and ard infection prophylaxis  that included preoperative intravenous antibiotics . Immediately before antibiotic administration and baseline aerobic and anaerobic cultures of the vaginal flora were obtained , which were followed by cultures at 30 minutes after the surgical scrub and hourly thereafter throughout each patient 's surgery . RESULTS A total of 50 patients were enrolled between October 2002 and September 2003 . There were no differences between the povidone iodine ( n = 27 ) and chlorhexidine ( n = 23 ) groups with respect to age , race , exogenous hormone use , body mass index , gravity , parity , preoperative mean colony counts , or operative time . Among the first set of intraoperative specimens ( which were obtained 30 minutes after the surgical scrub ) , 63 % of the cultures ( 17/27 ) from the povidone iodine group and 22 % of the cultures ( 5/23 ) from the chlorhexidine group were classified as contaminated ( P = .003 ; relative risk , 6.12 ; 95 % CI , 1.7 , 21.6 ) . Subsequent cultures failed to demonstrate significant differences . CONCLUSION Chlorhexidine gluconate was more effective than povidone iodine in decreasing the bacterial colony counts that were found in the operative field for vaginal hysterectomy STUDY OBJECTIVE To explore attitudes and hysterectomy practice s among gynecologists in the United States and to identify potential barriers to offering minimally invasive hysterectomies . DESIGN Mixed-mode ( online and on-paper ) survey of a r and om sample of 1500 practicing obstetrician-gynecologists . SETTING Nationwide survey in the United States . PARTICIPANTS Nonretired obstetrician-gynecologists identified through a physician list from the American Medical Association . INTERVENTIONS Postal and online survey . MEASUREMENTS & MAIN RESULTS : We received a response from 376 physicians ( 25.8 % response rate ) . The average age of respondents was 47.9 years , and 87 % were generalists . Participants performed on average 4 surgical cases per week and 32 hysterectomies per year , most of which were abdominal hysterectomies . When asked for preferred mode of access for themselves or their spouse , 55.5 % chose  vaginal hysterectomy ( VH ) , 40.6 % chose  laparoscopic hysterectomy ( LH ) , and 8 % chose  abdominal hysterectomy ( AH ) .  Younger physicians ( < 40 ) and high surgical volume physicians were significantly more likely to chose a laparoscopic approach and identified significantly fewer barriers for performing LH . The main barriers to performing VH were technical difficulty , potential for complications , and caseload of VH . The main barriers for performing LH were training during residency , technical difficulty , personal surgical experience and operating time . The majority of gynecologists wanted to decrease their AH rates and increase their LH rates . The most significant identified contraindications to VH were prior laparotomy , a uterus larger than 12 weeks , narrow introitus , adnexal mass , and minimal uterine descent . CONCLUSIONS While a large majority of gynecologists would prefer a VH or LH for themselves or their spouse , AH remains the most common hysterectomy method in the United States . A generation gap appears to be brewing with younger gynecologist more in favor of the laparoscopic approach . More emphasis should be placed on training gynecologists in performing minimally invasive hysterectomies , given their desire to change their surgical mode of access Purpose The medical and economic benefits of the transvaginal approach over the abdominal and laparoscopic methods are demonstrated in many studies .  Vaginal hysterectomy  with bipolar vessel sailing ( BiClamp ® ) represents an example of mininvasive surgery and could be a valid and cost-benefit alternative in the surgical treatment of benign gynaecologic disease .  BiClamp ® may be carried out according to Clavè ’s technique with a good result in postoperative pain . Methods Prospect i ve r and omized study ( Canadian Task Force classification I ) . We compared the  vaginal hysterectomy with salpingo-oophorectomies with Bi 
    Output:
    
We did not identify any patient characteristics precluding a vaginal approach ; chlorhexidine or povidone is appropriate for vaginal antisepsis ; vasopressin decreases blood loss by 130 cc ; tissue-sealing devices decrease blood loss by 44 cc and operative time by 15 minutes with uncertain complication implication s ; vertical cuff closure results in 1-cm increased vaginal length ; either peritoneum or epithelium can be used for colpotomy closure ; and routine vaginal packing is not advised .