Indications and Alternatives to Hysterectomy

Abstract

Hysterectomy remains one the most common procedures performed in North America. Because of a better understanding of a wide array of disease states and with emerging, more focused minimally invasive treatment options, a relative decline has been documented in the last several years. Although hysterectomy will ultimately eliminate all potential sources of abnormal uterine bleeding, various pharmacologic and surgical alternatives exist that may provide comparable benefit to the majority of women, especially if older than 40 years. Women experiencing chronic pelvic pain; however, should be counseled against hysterectomy until a more clear etiology has been identified.

Considering Decision-Making and Sexuality in Menstrual Suppression of Teens and Young Adults with Intellectual Disabilities

“…Of note, the fibroids in this case are a classic red herring. Fibroids, alone, are not an indication for hysterectomy [13]. Thus, there does not appear to be a bona fide medical indication for hysterectomy in this case at this time.…”

A laparoscopic study investigating 3D vs 2D imaging systems using a pelvitrainer model with experts, non-experts, and students

“…As this study suggests, surgeons should start using 3D systems early in their operating career, as the effects are substantial for beginners and the learning curve can be improved. This is especially important as there are fewer operations due to an increase in the number of conservative procedures based on better alternative treatments or diagnostics [21,22,23,24,25,26]. This is also an approach that may prove useful in increasing the use of robot-assisted LSC using simple tools.…”

Potential of minimally invasive procedures in the treatment of uterine fibroids: a focus on magnetic resonance-guided focused ultrasound therapy

“…Less invasive treatment options are available, such as uterine artery embolization (UAE), MRgFUS, or less common thermal ablation therapies using laser, radiofrequency, and cryoablation. 6 , 14 Medical therapy using hormone-based treatment is also available, 15 but may have a rebound effect once discontinued. 16 Hormone therapy is often used in patients who present with heavy menstruation or as a presurgical adjunct for those with large fibroids, as they reduce the endometrial hyperplasia associated with the fibroid (progestogens) and induce the shrinkage of the fibroid (GnRH-antagonist effect).…”

“…Uterine fibroids remain the most common indication for hysterectomy in the US. 6 , 14 However, hysterectomy is a major operation, and can cause significant disability for 2 months postoperatively. 17 , 18 The mortality rate is 0.38–1 per 1,000 patients, significant complications develop in 3% of patients, and minor complications are experienced by up to 30% of patients.…”