| February 2006 · Vol. 18, No. 2 SURGICAL TECHNIQUES
CONTROVERSIES IN PELVIC SURGERY
Hysterectomy: Which route for which patient?
The vaginal route—with or without laparoscopic assistance—is often preferable to laparotomy, but much less common.
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Fast Track
“Consider laparoscopic assistance for any patient who is not a candidate for vaginal hysterectomy” —Tommaso Falcone, MD
“In risk-reduction surgery for BrCa 1 or 2 mutations, an ovarian remnant may become a fatal oversight” —Thomas Herzog, MD
“One study followed 67 women for 66 months after supracervical hysterectomy; trachelectomy was required in 22.8% of patients” —Mickey Karram, MD
“Most uteri, regardless of size, can be safely and efficiently removed vaginally as long as there is access to the uterine vasculature” —Barbara Levy, MD
“It bodes ill when the current generation of residents attempts vaginal hysterectomy only in the simplest and most straightforward cases” —Mickey Karram, MD
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OUR EXPERT PANELISTS
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Moderator Mickey Karram, MD, Director of Urogynecology, Good Samaritan Hospital, Cincinnati, and Professor of Obstetrics and Gynecology, University of Cincinnati, Ohio.
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Tommaso Falcone, MD, Professor and Chairman, Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, Ohio.
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Thomas Herzog, MD, Director, Division of Gynecologic Oncology, Physicians and Surgeons Alumni Professor, Columbia University Medical Center, New York City.
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Barbara S. Levy, MD, Medical Director, Women’s Health Center, Franciscan Health System, Federal Way, Wash. Dr. Levy serves on the OBG MANAGEMENT Board of Editors.
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The vast majority of hysterectomies are for benign conditions—for which minimally invasive approaches would seem appropriate—yet the ratio of abdominal-to-vaginal hysterectomy is 3 to 1 or higher.1,2 Approximately 800,000 US women undergo hysterectomy each year.
Why the continued reliance on the abdominal approach despite convincing evidence that vaginal and laparoscopicassisted vaginal hysterectomy (LAVH) offer faster recovery, better cosmesis, and, in many cases, a shorter operation with fewer complications?
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