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Selecting the Route of Hysterectomy for Benign Disease

Obstet Gynecol; ePub 2017 Jun; Matteson, et al

The American College of Obstetricians and Gynecologists’ Committee of Gynecologic Practice has issued a committee opinion that offers recommendations on choosing the best route of hysterectomy for benign disease. The committee stresses that the obstetrician-gynecologist should discuss the options with patients and make clear recommendations on which route of hysterectomy will maximize benefits and minimize risks given the specific clinical situation. Recommendations and conclusions include:

  • Vaginal hysterectomy is the approach of choice whenever feasible.
  • Laparoscopic hysterectomy is a preferable alternative to open abdominal hysterectomy for those patients in whom a vaginal hysterectomy is not indicated or feasible.
  • For an individual patient, the surgeon should account for clinical factors and determine which route of hysterectomy will most safely facilitate removal of the uterus and optimize patient outcomes.
  • Selection of the route of hysterectomy for benign causes can be influenced by the size and shape of the vagina and uterus; accessibility to the uterus; extent of extrauterine disease; the need for concurrent procedures; surgeon training and experience; average case volume; available hospital technology, devices, and support; whether the case is emergent or scheduled; and preference of the informed patient.
  • The relative advantages and disadvantages of the approaches to hysterectomy should be discussed in the context of the patient’s values and preferences.
  • Opportunistic salpingectomy usually can be safely accomplished at the time of vaginal hysterectomy.

Citation:

Choosing the route of hysterectomy for benign disease. Committee Opinion No. 701. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2017:129:e155–9.