Surgical approaches to hysterectomy

Neil Johnson, Anne Lethaby

Hysterectomy is usually the last resort for women suffering from severe menstrual disorders. Removing the uterus will end painful symptoms, but fertility is permanently destroyed in the process. There are now several different approaches to performing hysterectomy, should this surgery become unavoidable.

Neil Johnson and Anne Lethaby conducted a large systematic review of 27 randomised trials to compare abdominal, vaginal and laparoscopic hysterectomy. Abdominal hysterectomy involves removal of the uterus through a large incision on the lower abdomen; vaginal hysterectomy removes the uterus via the vagina, with no abdominal incision. Laparoscopic hysterectomy removes the uterus through the vagina with the aid of a surgical telescope (laparoscope) and microsurgical tools inserted through small abdominal incisions.

The review found that vaginal hysterectomy, where it was possible, was associated with the fewest complications. A laparoscopic approach provides similar advantages over abdominal hysterectomy, but it takes longer than vaginal hysterectomy, requires more surgical skill and has a higher chance of injury to the bladder or ureter. The review concluded that vaginal hysterectomy should be preformed in preference to abdominal hysterectomy. Where this is not possible, a laparoscopic approach may avoid the need for abdominal hysterectomy.

To read the full Cochrane Review, please click on the link

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