Hysterectomy (removal of the uterus) is one of the most frequently performed surgical procedures in the US. Approximately 600,000 hysterectomies are performed each year. The most common reason for hysterectomy is fibroids (40.7%), followed by endometriosis (17.7%), and uterine prolapse (14.5%). Hysterectomy can be performed by several methods: via an open incision in the abdomen; through small incisions in the abdomen with the aid of a laparoscope; or through a small incision in the vagina. The standard procedure to remove the uterus has been through an open incision in the abdomen, but it is more invasive and requires the longest recovery time when compared to newer techniques which generally have shorter hospital stays and a faster return to normal activity for women. However, current national data show that the standard abdominal hysterectomy method is performed in 66% of cases. Vaginal hysterectomy is performed in 22% of cases and laparoscopic hysterectomy in 12% of cases.
“Vaginal hysterectomy is better for women in terms of fewer complications and quicker recoveries compared with abdominal or laparoscopic surgery,” says Cheryl B. Iglesia, MD, of Washington Hospital Center in Washington, DC, and chair of ACOG’s Committee on Gynecologic Practice. “Vaginal hysterectomy also is the most cost-effective method.”
Although vaginal hysterectomy is the approach of choice, it’s not always feasible in every situation. “The paramount concern is that we provide the safest procedure for our patients. That being said, based on the national data, it’s pretty clear that more hysterectomies in the US could be performed using the less invasive vaginal approach than are currently being done,” says Dr. Iglesia.
Physicians should consider which surgical procedure is safest and the most cost-effective to meet the needs of each patient undergoing hysterectomy, according to ACOG. A number of factors may influence the route of hysterectomy, including the size and shape of the vagina and uterus; accessibility to the uterus; surgeon training and experience; extent of disease; available hospital technology, devices, and support; and the preference of the informed patient.
Committee Opinion #444, “Choosing the Route of Hysterectomy for Benign Disease,” is published in the November 2009 issue of Obstetrics & Gynecology.
# # #
The American College of Obstetricians and Gynecologists (ACOG) is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of approximately 56,000 members, ACOG strongly advocates for quality health care for women; maintains the highest standards of clinical practice and continuing education of its members; promotes patient education; and increases awareness among its members and the public of the changing issues facing women’s health care.