Formal institutional guidelines promotes the vaginal approach to hysterectomy in patients with benign disease and non-prolapsed uterus

Cost Analysis of Vaginal Hysterectomy as Compared to Laparoscopic Assisted Vaginal Hysterectomy for Non-prolapse Uterus in a Tertiary Institution in South Africa

“…The results of this study are in agreement with those of other studies [14][15][16][17][18] which, clearly demonstrate that VH is less costly, and provides the same advantages as LAVH, namely less postoperative pain, less need of analgesia, shorter hospital stay, and a more rapid recovery and return to daily activities. Key measures used in this study to assess cost difference amongst the two procedures were related to operating time in theatre per minute, and the use of consumables during LAVH.…”

“…This latter indication accounts for about 10% of all hysterectomies conducted worldwide [12,13]. The advantages provided by vaginal hysterectomy (VH) or laparoscopic hysterectomy (LH), either total laparoscopic hysterectomy (TLH) or laparoscopic assisted vaginal hysterectomy (LAVH) over abdominal hysterectomy (AH) include less postoperative pain, less need of analgesia, shorter hospital stay, more rapid recovery and return to daily activities, and reduced hospital charges [14][15][16][17][18] Additionally, intra-operative and post-operative complications reported with VH as compared with AH or LH are much less [19][20][21]. Despite the benefits offered by VH, the advent of laparoscopic approaches had little effect in reducing the rate of AHs.…”

Is an enlarged fibroid uterus a contraindication for Non-Descent Vaginal Hysterectomy (NDVH)? Retrospective comparison between cohort whose uterine size ≥ 12 weeks and cohort whose uterine size less than 12 weeks underwent NDVH.

“…This leads to, the United Healthcare company in USA to demand prior approval for all hysterectomies except those executed vaginally on an outpatient basis beginning April 2015 and, the FDA commended that surgeon no more use laparoscopic power morcellators for hysterectomy or myomectomy in most patients with uterine leiomyomas because of the hazard of disseminating occult cancer (66)(67)(68) . Also, lots of authors and communities has been succeeded in achieving higher rates of VH on expanses of TAH, as in Finland, VH rates improved from18% in 1996 to 44% in 2006 (20) , in Sweden from 4% in 1987 to 31% in 2003 (31) , in university of Witwatersrand, Johannesburg, south Africa where rates of TAH/VH changed from 9/1 in 2001 to 1/1 at 2014 (49,54) . Hence, it is crucial to ensure that gynecologists have proper training in performing VH for benign disorders (33,34) as well as possess a comprehensive understanding of the indications (66)(67)(68) , the real and the alleged contraindications with VH (20)(21)(22)(23)(24)(25) .…”

“…The size of the uterus can affect the ease of removal, and it is unclear whether an enlarged uterus is a contraindication for NDVH (1,4) . The large sized uterus more than 12 week was considered a traditional contraindication by most acting gynecologists who were surveyed for their opinion regrades routs for hysterectomy for benign gynecological diseases as stated in SGS's systematic review attributable to uncertainties about increased technical difficulty and risk of complications (31,33,34) , despite that a lot of pioneered gynecologists worldwide including American (2,3,(35)(36)(37)(38)(39)(40)(41)(42)(43)(44) , Canadian (45) , English (46)(47)(48)(49) , Indian (23,50,51) , Chinese (52) , Malaysian (53) ,south Africans (8,9,45,54) , French (4,(55)(56)(57) , polish (1,58) , Italian (59)(60)(61) , Greece (62) , Turkan (63)(64)(65) had been challenged the alleged uterine size as a contraindication for NDVH and they had succeeded in that task with great safety. Therefore, the goal of this retrospective research is to determine...…”

¿Cómo decidir el abordaje más adecuado para realizar una histerectomía por patología benigna? Revisión bibliográfica

“…Chrysostomou et al muestran un incremento importante de la tasa de la vía vaginal (desde el 9.8 al 48.4%) y la disminución de la vía abdominal (del 91.2 al 51.6%), consiguiendo un ratio vaginal/abdominal de 1/1, tras implementar un algoritmo en la toma de decisión de la ruta de abordaje en la histerectomía. Los criterios de decisión eran la accesibilidad uterina, un tamaño uterino de hasta 14 semanas o 360 g y de diámetro inferior a 9 cm, y la ausencia de patología extrauterina 33 . Un estudio retrospectivo de cohortes evalúa los cambios en la práctica clínica tras la introducción de la cirugía robótica en un centro que utilizaba un algoritmo para decidir el abordaje de una histerectomía.…”