Surgical approach to hysterectomy for benign gynaecological disease

Abstract

Among women undergoing hysterectomy for benign disease, VH appears to be superior to LH and AH, as it is associated with faster return to normal activities. When technically feasible, VH should be performed in preference to AH because of more rapid recovery and fewer febrile episodes postoperatively. Where VH is not possible, LH has some advantages over AH (including more rapid recovery and fewer febrile episodes and wound or abdominal wall infections), but these are offset by a longer operating time. No advantages of LH over VH could be found; LH had a longer operation time, and total laparoscopic hysterectomy (TLH) had more urinary tract injuries. Of the three subcategories of LH, there are more RCT data for laparoscopic-assisted vaginal hysterectomy and LH than for TLH. Single-port laparoscopic hysterectomy and RH should either be abandoned or further evaluated since there is a lack of evidence of any benefit over conventional LH. Overall, the evidence in this review has to be interpreted with caution as adverse event rates were low, resulting in low power for these comparisons. The surgical approach to hysterectomy should be discussed and decided in the light of the relative benefits and hazards. These benefits and hazards seem to be dependent on surgical expertise and this may influence the decision. In conclusion, when VH is not feasible, LH may avoid the need for AH, but LH is associated with more urinary tract injuries. There is no evidence that RH is of benefit in this population. Preferably, the surgical approach to hysterectomy should be decided by the woman in discussion with her surgeon.

Enhanced recovery after surgery (ERAS) versus conventional postoperative care in patients undergoing abdominal hysterectomies

“…Even though, less invasive approaches such as laparoscopic or vaginal procedures are suggested primarily, the standard procedure for most cases is abdominal hysterectomy [7,8]. The major causes for counselling vaginal or laparoscopic hysterectomy over the abdominal method is earlier beginning of routine actions, shorter hospital stay, fewer bleeding, and fewer infections.…”

“…The major causes for counselling vaginal or laparoscopic hysterectomy over the abdominal method is earlier beginning of routine actions, shorter hospital stay, fewer bleeding, and fewer infections. On the other hand, these advantages might be at the expense of further injuries of the urinary tract and extended surgery time for laparoscopic approaches [8].…”

A comparative study of total laparoscopic hysterectomy and non-descent vaginal hysterectomy for treatment of benign diseases of uterus

“…4 It is a general consensus that Vaginal Hysterectomy is considered the gold standard compared to Total Laparoscopic Hysterectomy. 5 Non-Descent Vaginal Hysterectomy is a very simple yet effective technique for tackling benign pathologies of the uterus. It is easy to master, causes less blood loss, pain and discomfort to the patient when compared to the conventional total abdominal hysterectomy.…”

Total laparoscopic hysterectomy versus vaginal hysterectomy: a retrospective study

“…However, the evidence in this review has to be interpreted with caution as adverse event rates were low, resulting in low power for this comparisons. 6 From a technical point of view, laparoscopic approach benefits include high-definition imaging and vision amplification, allowing for an easier access to the uterine vessels, ureter, rectum and vagina. 7 Despite the initial controversy regarding laparoscopic approach-related complication rate, most recent studies are consensual and present TLH as a safe and first-line technique in multiple surgical scenarios, either benign or malignant.…”