Alternative Techniques of Hysterectomy

Abstract

Our fax numbers: 617-739-9864 and 617-734-4457Our e-mail address: letters@nejm.orgWe cannot acknowledge receipt of your letter, but we will notify you when we have made a decision about publication. We are unable to provide prepublication proofs. Please enclose a stamped, self-addressed envelope if you want unpublished material returned to you. Financial associations or other possible conflicts of interest must be disclosed. Submission of a letter constitutes permission for the Massachusetts Medical Society, its licensees, and its assignees to use it in the Journal 's various editions (print, data base, and optical disk) and in anthologies, revisions, and any other form or medium. 290 ؒ Januar y 23, 1997The New England Journal of Medicine 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....