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Correspondence
Alternative Techniques of HysterectomyTo the Editor: With regard to the articles on alternative techniques of hysterectomy by Dorsey et al. and Weber and Lee and the accompanying editorial by Stovall and Summitt (Aug. 15 issue), 1-3 the terms "laparoscopic hysterectomy" and "laparoscopically assisted vaginal hysterectomy" require clarification. Laparoscopic hysterectomy entails the complete separation of the uterus from its vascular, vaginal, and connective-tissue attachments, which is accomplished entirely by means of laparoscopic manipulation. Laparoscopically assisted vaginal hysterectomy may be no more than a laparoscopic visualization of the pelvic viscera followed by a standard vaginal hysterectomy. In between these two procedures are those that involve stapling, burning, or ligating the various uterine attachments, including separation of the bladder from the lower uterine segment. Although all these procedures fall under the general heading of laparoscopically assisted vaginal hysterectomy, they vary enormously in terms of operating time, cost of disposable surgical materials, and required operative skill.Several trends are coming into clearer focus. When the cost of disposable equipment is charged to the physician, laparoscopically assisted vaginal hysterectomy will disappear. With the newly recognized subspecialty of pelvic reconstructive surgery and urogynecology, hysterectomies will be performed in greater numbers by fewer and more experienced gynecologists. With more experience in performing vaginal hysterectomies, gynecologists become less dependent on the laparoscope to remove the uterus.The differences in morbidity and length of convalescence between abdominal and vaginal hysterectomy are diminishing. Patients now leave the hospital two to three days after an abdominal hysterectomy and return to work weeks earlier than they used to. In addition, the clear demonstration of the cardioprotective effect of postmenopausal estrogen therapy 4 will contribute to an increased use of hormone-replacement therapy for women. The benefit of such therapy will result in an increased number of hysterectomies in women with myomas, family histories of endometrial cancer, or an intolerance of progestogens.1. Dorsey JH, Holtz PM, Griffiths RI, McGrath MM, Steinberg EP....
