Hysterectomy Trends: A Canadian Perspective on the Past, Present, and Future

Abstract

W ith more than 41 000 hysterectomies performed annually in Canada, surgical removal of the uterus is a cornerstone of gynaecologic surgery. 1 Soranus of Ephesus is credited with performing the first hysterectomy in the second century CE. He removed a gangrenous prolapsed uterus vaginally; however, the bladder and ureters were also transected. 2 Another notable case is that of Faith Howard, who in 1670 performed an auto-amputation for a completely prolapsed uterus. Although she survived the surgery, she experienced "water passing from her insensible day and night." 3

The global proliferation of radical gynaecological surgeries: A history of the present

“…Current medical debates about the consequences of hysterectomy A group of Canadian ob-gyn researchers referred to hysterectomy in 2019 as a continuing 'cornerstone of gynaecological surgery', noting that the surgery remains widely recommended to women considered peri-or post-menopausal, seeking removal of fibroid leiomyomas (non-cancerous benign tumours) despite alternative treatments such as myomectomy being well developed (Chen, Choudhry, and Tulandi 2019). Such benign tumours have been estimated to occur in more than half of all women by the age of 50 years (Wang et al 2016).…”

“…In numerous affluent contexts, many gynaecologists continue to prefer hysterectomy as a treatment where other options exist since it is both a less technically demanding surgery, entails less blood loss than many others, and is seen as cancer prophylactic. Nonetheless, there have been variable declines in hysterectomy since the 1990s in several affluent countries with long histories of their ubiquity, such as France, Denmark, the USA and Canada, due to the development of alternative procedures for the treatment of non-cancerous uterine fibroidsthe single most common condition for which hysterectomy is prescribed (Theobald 2008;Gimble, Settnes, and Tabor 2001;Chen, Choudhry, and Tulandi 2019;Farris et al 2019). Laparoscopic or hysteroscopic myomectomy (minimally invasive removal of the fibroid but not the uterus, by abdominal or vaginal entry) is now considered 'the gold standard surgical treatment option for fibroids' (Malick and Odejimi 2017).…”

“…It is neither driven solely by ongoing concerns, but nor is it of purely antiquarian interest, instead 'problematizing' (Castel 1994) gynaecological surgeries from the moment of their widespread historical appearance up to the present, attending to both the continuities and discontinuities of context, clinical rationale and practice. Surgeries entailing the removal of women's internal reproductive organs (uterus, cervix, ovaries, fallopian tubes) have constituted the vast majority of gynaecological surgeries throughout their history (Lepine et al 1997;Chen, Choudhry, and Tulandi 2019). Our inquiries suggest a highly diffuse set of networks through which gynaecological surgeons and researchers have been entangled in biopolitics, at times non-deliberately and unconsciously through clinical research and practice, without being part of the explicit structures of the state; at other times through eugenic or other conceptual commitments in their management of specific 'populations', in state-funded clinics.…”

Avoidable bilateral salpingo-oophorectomy at hysterectomy: a large retrospective study

“…ysterectomy is a major gynecologic surgery and is one of the most commonly performed procedures among women outside of pregnancy. 1,2 In Canada, approximately 41,000 hysterectomies are performed annually, 3 with more than 90% being performed for benign indications such as abnormal uterine bleeding (AUB), uterine leiomyoma, adenomyosis, or endometriosis. 3,4 Several hysterectomy routes exist including laparoscopic, vaginal, and abdominal approaches.…”

“…1,2 In Canada, approximately 41,000 hysterectomies are performed annually, 3 with more than 90% being performed for benign indications such as abnormal uterine bleeding (AUB), uterine leiomyoma, adenomyosis, or endometriosis. 3,4 Several hysterectomy routes exist including laparoscopic, vaginal, and abdominal approaches. In addition, bilateral salpingo-oophorectomy (BSO) may be performed at the time of hysterectomy, with multiple retrospective studies reporting up to 50% of hysterectomies being accompanied by removal of both ovaries.…”