Introduction of Laparoscopic Hysterectomy Approach: Decreasing the Abdominal Hysterectomy Approach or Replacing Vaginal Hysterectomy

Abstract

CitationMcLeod JB, Cao J, Spiryda LB. Introduction of laparoscopic hysterectomy approach: decreasing the ab- It has been noted in the medical literature that abdominal hysterectomy rates continue to be over 66%, with less than one-third of hysterectomies performed via minimally invasive approaches despite the rapidity of recovery. We compared trends in hysterectomy routes for the years 2000 and 2010 at our institution. Methods: Expedited IRB approval was obtained for a retrospective chart review of all hysterectomies performed during 2000 and 2010. Medical records were abstracted for basic demographics, including age, Body Mass Index (BMI), uterine size (grams), and route of hysterectomy (laparoscopic, vaginal, laparotomy). Laparoscopic approaches included Total Laparoscopic Hysterectomy (TLH), Laparoscopic Supracervical Hysterectomy (LSH), Laparoscopy Assisted Vaginal Hysterectomy (LAVH), and Da Vinci robotic hysterectomy. Standard statistical analysis was performed using JMP statistical programming. Results: No differences were found between mean age and racial distribution in the years analyzed. In 2000 and 2010, 50% of hysterectomies were performed using minimally invasive techniques. In 2000, 47% were performed via the vaginal route whereas in 2010, 47.7% were performed via laparoscopy. When patients were stratified by weight class, obese women (BMI>30) had a statistically significant greater number of hysterectomies performed via the abdominal route when compared to normal weight women; this was independent of uterine weight. African-American women were also found more likely to have an abdominal hysterectomy, but once controlled for uterine weight, this difference dissipated. Conclusions: At our institution, 50% of hysterectomies were performed using minimally invasive techniques in both 2000 and 2010, with laparoscopic approaches essentially replacing vaginal hysterectomies by 2010 without affecting abdominal hysterectomy rates. Minimally invasive approaches continue to lag in obese women.

Race, class, caste, disability, sterilisation and hysterectomy

“…Even those teleological narratives recounting the history of gynaecological surgery as the triumph of men’s science over women’s folk medicine and which refer to a progressive refining of modern surgical technique, have nonetheless often also acknowledged that the safer and more technical methods have often not been widely favoured in practice ( O’Dowd and Philipp 1994 , vii; Litynski 1999 ). Several recent gynaecology researchers have pointed to a significant deskilling of surgeons in the late twentieth century, in the relative decline of the more technically demanding vaginal hysterectomy with its shorter recovery time for patients, and an increase of the technically simpler, open-cut abdominal-entry methods which leave visible scars, are more painful, require longer convalescence, and are more likely to impact women’s core-muscular function, pelvic integrity and bladder control postsurgery ( McCloud, Cao, and Spiryda 2015 ; Panza, Heft, and Zimmerman 2018 ).…”

Surgical Skills Simulation Center Implementation: Healthcare Continuous Quality Improvement Project

“…Based on a healthcare cost and utilization project (HCUP) database search, the most frequent gynaecologic procedures (excluding termination of pregnancy and dilation and curettage) in community hospitals totalled 1,649,000 in 2012, a 796,824 decline from 2,445,824 in 2007 [1]. Hysterectomies in particular decreased 247,613 from 681,234 in 2002 to 433,621 in 2010 [2]. The introduction of roboticassisted surgery further reduced resident participation in surgery [3].…”