Overview of Current Trends in Hysterectomy

Santiago Domingo; Antonio Pellicer


Expert Rev of Obstet Gynecol. 2009;4(6):673-685. 

In This Article


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.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.