Thanks for the roundtable discussion of hysterectomy (“Hysterectomy: Which route for which patient?” moderated by Dr. Mickey Karram [February]). I believe the art of vaginal hysterectomy is dying, despite the fact that it allows me to finish the procedure in 30 to 45 minutes, remove ovarian cysts, and do an appendectomy, salpingo-oophorectomy, or other necessary procedures.
A uterus as big as a fetal head can be removed vaginally, although, occasionally, excision of fibroids and/or morcellation is necessary before the operation can be completed, as Dr. Karram and the panelists point out. Meddlesome surgery, like meddlesome midwifery, should be discouraged.
To convert a simple vaginal hysterectomy to a laparoscopic procedure costing several hours of OR time and wasting more than $2,000 of disposable instruments and supplies is insane. By the same token, with the modern technology available, it would be wrong to resort to vaginal hysterectomy in overly difficult cases.
As for training the next generation of surgeons, I believe residents need to learn vaginal hysterectomy before they are allowed to do the laparoscopic procedure.
Hamid H. Sheikh, MD