Overview of Current Trends in Hysterectomy

Authors and Disclosures

Santiago Domingo, MD
Department of Obstetrics and Gynecology, Hospital Universitario La Fe, Avda, Campanar 21, 46009 Valencia, Spain. Tel.: +34 963 050 985, Fax: +34 963 050 999, sdomingo@ivi.es

Antonio Pellicer, MD
Department of Obstetrics and Gynecology, Hospital Universitario La Fe, Avda, Campanar 21, 46009 Valencia, Spain. Tel.: +34 963 050 985, Fax: +34 963 050 999, apellicer@ivi.es

^†Author for correspondence
Department of Obstetrics and Gynecology, Hospital Universitario La Fe, Avda, Campanar 21, 46009 Valencia, Spain. Tel.: +34 963 050 985, Fax: +34 963 050 999, apellicer@ivi.es

Sidebar: Key Issues

Key Issues

• Hysterectomy is one of the most prevalent surgeries in the female population and, although a vaginal route is recommended by many institutions, a laparotomy is still commonly performed.

• Hysterectomy indications show a slow but continuous diminution owing to the availability of more conservative approaches, including levonorgestrel-releasing intrauterine devices, ablation techniques and uterine embolization, which have been shown to be safe and cost effective.

• Menorrhagia is the first cause of surgery, mainly as a result of myomas and adenomyosis. Other common indications are genital prolapse and malignancy.

• Hysterectomy appears to be cost effective as a treatment for menorrhagia compared with endometrial resection, ablation and medical therapy at long-term follow-up.

• The vaginal route is the most cost-effective approach to hysterectomy, and has been shown to be an effective and cost-effective intervention for a variety of indications.

• Vaginal hysterectomy should be the first choice when selecting the route of intervention. Laparoscopic surgery (assistance or a total hysterectomy) should be performed if an absolute/relative contraindication is suspected.

• Parity, uterine size, vaginal anatomy, pelvic mobility and any pelvic disease or previous pelvic surgery are the most important factors influencing the choice of hysterectomy route. The most transcendental of all is the skill of the surgeon in question.

• Uterine size should not be an indication for abdominal surgery, as vaginal morcellation is a safe and effective alternative in such cases.

• The preservation of ovaries until the age of at least 65 years is associated with higher survival rates, as this prevents cardiovascular disease and hip fracture.

• Abdominal hysterectomy should be performed only when pathological circumstances and patient characteristics preclude the vaginal/laparoscopic route.