Abdominal or vaginal hysterectomy for enlarged uteri: A randomized clinical trial

Why do we argue about route of hysterectomy? A call for dialogue

“…Doing 80% of these patients via the vaginal route would translate to a vaginal hysterectomy rate of 40%. In addition, cases series and randomized controlled trials (from USA and international authors) confirm that this higher rate is feasible [1][2][3][4].…”

Is Embolization Equal to Hysterectomy in Treating Uterine Fibroids?

“…Laparoscopic hysterectomy is moderately invasive. Vaginal hysterectomy is and has always been the most minimally invasive hysterectomy (ACOG Committee Opinion, 2009;Benassi et al, 2002;Dodero et al, 2007;Gimbel, 2005;Kovac et al, 2002;Nieboer et al, 2009). No amount of spin can deny this fact.…”

“…Because the majority of hysterectomies are safe and successful operations, and most patients recover well over time, surgical decision making is often only questioned when a complication occurs. Some authors also noted a 3 to 5 fold increase in subtotal hysterectomy worldwide (Johns, 1997;Benassi et al, 2002;Dodero et al, 2005;Nieboer et al, 2009). This change in preference is hard to explain, given the lack of evidence to support this practice.…”

“…Physicians should take into consideration how the procedure may be performed safely and costeffectively to fulfill the medical needs of the patient. However, analysis of recent surgical data shows that abdominal hysterectomy is performed in 66% of cases, vaginal hysterectomy in 22% of cases, and laparoscopic hysterectomy in 12% (ACOG Committee Opinion, 2009;Benassi et al, 2002;Kovac et al, 2002;Nieboer et al, 2009). Not all hysterectomies demand a specific operative approach; that is, some hysterectomies can be performed vaginally, laparoscopically, or abdominally for similar indications.…”

“…Most likely physician and patient perception of the merit of subtotal hysterectomy had a significant influence: women may believe subtotal hysterectomy may have less impact on sexuality, while physicians might consider the procedure less likely to effect bowel and bladder function and to have lower rates of infectious morbidity, be less likely to lead to prolapse, and have lower operative time and less blood loss than total abdominal hysterectomy. Given the lack of convincing evidence favoring this approach, the motivating reasons behind this change in practice pattern remain unclear (Johns, 1997;Benassi et al, 2002;Dodero et al, 2005;Nieboer et al, 2009). …”