The least invasive approach to hysterectomy—and the route burdened with the least complications—is still the plain old bread-and-butter vaginal hysterectomy, with or without oophorectomy. This is what needs to be emphasized—not the smoke and mirrors of laparoscopic supracervical hysterectomy or total laparoscopic hysterectomy. Laparoscopic skills are nice, but we do not do enough simple vaginal hysterectomies.
Contraindications to the vaginal approach are really quite few. In contrast to Dr. Barbieri, who advocated ensuring that every major gynecologic service has at least 1 gynecologic surgeon competent in total laparoscopic hysterectomy, I believe it is more important to have a surgeon adept at vaginal approaches and a medical staff willing to use those skills. This is how we bring our abdominal rate down and our vaginal approach up. This is how we decrease known morbidities of surgery and bring about true improvement in women’s health.
There is no reason that a skilled surgeon should not perform 70% or more of hysterectomies using the vaginal approach.
Gerrit J. Schipper, MD