Moving from vaginal hysterectomy to “no-incision” hysterectomy: how terminology has an impact

Abstract

It is estimated that one in three women undergo hysterectomy in the USA, with the majority of these procedures performed via open abdominal surgery [1]. It is well known that morbidity related to hysterectomy can be reduced by using less invasive surgical techniques, such as vaginal and laparoscopic approaches. In some countries, the proportion of vaginal hysterectomies is over 40 % and in others, the proportion of laparoscopic hysterectomies is over 80 %, with a resultant decreased number of abdominal hysterectomies being performed [2,3]. However, despite the availability of vaginal hysterectomy for over a century and that of laparoscopic hysterectomy for almost three decades, the most common procedure currently performed worldwide is still abdominal hysterectomy. Recently, robotic hysterectomy has been introduced and has been rapidly adopted in some countries, including the USA. Despite a lack of scientific evidence supporting its routine use, it is estimated that robotic hysterectomy now accounts for over 40 % of hysterectomies in some areas of the USA [4].The fact that there has been a concomitant drop in the abdominal hysterectomy rate would seem to vindicate the use of the robotic approach for hysterectomy, but use of the robot has also reduced the use of other minimally invasive surgery (MIS) techniques such as vaginal and laparoscopic hysterectomy [5]. With scientific evidence supporting the use of vaginal and laparoscopic hysterectomy, how is it that robotic hysterectomy has become the predominant approach? It cannot be denied that the aggressive industry-supported marketing of robotic hysterectomy has influenced decisionmaking by patients, hospitals, surgeons. In fact, this has also resulted in the renewed marketing of traditional laparoscopic hysterectomy, which has had to coin the new term Bstraightstick laparoscopy^to differentiate it from Brobotic-assisted laparoscopy^.Aggressive competition has now led to a myriad of new terms and acronyms (some of them actually trademarked), which leave patients, and even many surgeons, unclear on the specifics of each technique. In addition to the basic terms abdominal hysterectomy (AH), laparoscopic hysterectomy (LH), robotic hysterectomy (RH), and vaginal hysterectomy (VH), the following terms have also appeared in recent medical literature and patient materials: da Vinci hysterectomy (dH), da Vinci single-site hysterectomy (dSSH), laparoendoscopic single-site hysterectomy (LESS), robotic-assisted laparoscopic hysterectomy (RALH), robotic total vaginal NOTES [natural orifice translumenal endoscopic surgery] hysterectomy (RTVNH), robotic vaginally assisted NOTES hysterectomy (RVANH), single-incision laparoscopic surgery hysterectomy (SILS), single-site hysterectomy (SSH), total intrafascial laparoscopic hysterectomy (TAIL), vaginal access minimally invasive surgery hysterectomy (VAMIS), and vaginally assisted NOTES hysterectomy (VANH). This terminology seems to feed into our human nature that drives us to assume that newer, technological-sounding terms indicate...