Hysterectomy rates are diminishing over time owing to new and effective conservative alternatives. When this intervention is selected, there are aspects that need to be considered in order for the best route to be selected. Although gynecologists should be trained in the three routes previously described (vaginal, laparoscopic and abdominal), a rational algorithm should be employed in clincial decisions. VH should be the first choice for many reasons, the most important of which are lower complication rate, better cost–effectiveness and improved QoL. The aim of any hysterectomy guideline is to avoid a laparotomy whenever possible. However, it seems that education concerning appropriate hysterectomy routes is mistaken in its objectives, as the literature continues to demonstrate a conflict between vaginal and laparoscopic approaches. Current gynecological practice should focus on performing fewer AHs and more LHs and VHs. Which one of the latter two approaches should be chosen? Given that the advantages of LH are similar to those of VH, we would say that the vaginal route is preferable, but this is a decision that depends heavily on the skills of the surgeon and the facilities available.
Expert Rev of Obstet Gynecol. 2009;4(6):673-685. © 2009 Expert Reviews Ltd.
Cite this: Overview of Current Trends in Hysterectomy - Medscape - Nov 01, 2009.