|July 2002 · Vol. 14, No. 7
Determining the best route for hysterectomy
Once a hysterectomy is indicated for the treatment of gynecologic disease, the surgeon must determine the safest and most efficient route—abdominal, vaginal, or laparoscopic-assisted vaginal. Here, the authors outline each approach, including patient selection, technical pearls, and advantages and disadvantages.
Dr. Cardosi is clinical assistant professor at the University of Florida at Pensacola. Dr. Hoffman is professor and division and fellowship program director in the division of gynecologic oncology at the University of South Florida College of Medicine in Tampa.
Choose the abdominal route when extensive intraperitoneal surgery and/or exploration are required in addition to the hysterectomy, i.e., in cases of pelvic organ carcinoma.
Use a combination of uterine morcellation techniques to accomplish a vaginal hysterectomy, as researchers have found morcellation of an enlarged uterus to be safer than removing it abdominally.
For laparoscopic-assisted vaginal hysterectomy, use 3 ports and avoid most disposable instruments by using cautery on vascular pedicles to help minimize costs.
Seek alternatives to abdominal hysterectomy given its less favorable outcome in terms of morbidity and recovery.
While hysterectomy is one of the most frequently performed operations in gynecology, how to perform it—abdominally, vaginally, or laparoscopically—is less evident. Numerous studies have been published in an attempt to shed some light on this controversy.
Individualize the approach for each patient rather than rely on a dogmatic assignment of technique.