Menopause: The Journal of The North American Menopause Society Vol. 22, No. 1, pp. 9/11 DOI: 10.1097/gme.0000000000000388 * 2014 by The North American Menopause Society
EDITORIAL Laparoscopic or vaginal hysterectomy?
H
ysterectomy is the most common major gynecologic surgical procedure. In 2010, approximately 430,000 hysterectomies were performed in the United States.1 Seventy percent of hysterectomies are performed for benign surgical indications, including abnormal uterine bleeding (21%), uterine fibroids (33%), pelvic pain (3%), and uterine prolapse (28%).2 Abdominal and vaginal routes have traditionally been the most common surgical approaches, though a substantial number of hysterectomies in the last decade have been performed laparoscopically.3 In a recent study by Wright et al,4 41% of hysterectomies were abdominal, 30% were laparoscopic, 20% were vaginal, and 10% were robotic. Current standard gynecologic practice dictates that vaginal route be the preferred surgical route whenever feasible. According to BACOG Committee Opinion No. 444: choosing the route of hysterectomy for benign disease,[ vaginal hysterectomy (VH) is the approach of choice whenever feasible.5 It further cites that laparoscopic hysterectomy (LH) is an alternative to abdominal hysterectomy for women in whom a VH is not indicated or feasible. However, several recent randomized trials comparing total LH with VH have been published, with conflicting results.6
EDITORIAL Laparoscopic or vaginal hysterectomy?
H
ysterectomy is the most common major gynecologic surgical procedure. In 2010, approximately 430,000 hysterectomies were performed in the United States.1 Seventy percent of hysterectomies are performed for benign surgical indications, including abnormal uterine bleeding (21%), uterine fibroids (33%), pelvic pain (3%), and uterine prolapse (28%).2 Abdominal and vaginal routes have traditionally been the most common surgical approaches, though a substantial number of hysterectomies in the last decade have been performed laparoscopically.3 In a recent study by Wright et al,4 41% of hysterectomies were abdominal, 30% were laparoscopic, 20% were vaginal, and 10% were robotic. Current standard gynecologic practice dictates that vaginal route be the preferred surgical route whenever feasible. According to BACOG Committee Opinion No. 444: choosing the route of hysterectomy for benign disease,[ vaginal hysterectomy (VH) is the approach of choice whenever feasible.5 It further cites that laparoscopic hysterectomy (LH) is an alternative to abdominal hysterectomy for women in whom a VH is not indicated or feasible. However, several recent randomized trials comparing total LH with VH have been published, with conflicting results.6
