Hysterectomy is the second most commonly performed surgical procedure in the United States. The indications for hysterectomy have changed little over the last decade. In spite of a large number of potential alternatives to hysterectomy for the management of benign disease, hysterectomy rates have remained relatively stable. The informed consent process for hysterectomy requires discussion of several important considerations, such as the risks and benefits of prophylactic oophorectomy and the need for removal of the cervix. The preponderance of studies on hysterectomy outcomes has shown improvement of pelvic symptoms and quality of life. Attention to perioperative details such as prophylactic antibiotics and prevention of venous thromboembolic events are important to assure a safe outcome. Laparotomy is still the most common route for hysterectomy. Large prospective controlled trials and a Cochrane review have clearly shown that vaginal hysterectomy is the surgical route of choice for hysterectomy. In our experience, previous cesarean delivery, large uterus, or request for removing the ovaries are not valid reasons for excluding vaginal hysterectomy as an approach.
Hysterectomy is associated with excellent outcomes when conservative measures fail; vaginal hysterectomy is associated with best outcomes compared with laparoscopic or abdominal approaches.
From the 1Department of Obstetrics and Gynecology, Cleveland Clinic; and 2Center of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, Ohio.
Corresponding author: Tommaso Falcone, Cleveland Clinic, Department of Obstetrics and Gynecology, 9500 Euclid Avenue A81, Cleveland, OH 44195; e-mail: firstname.lastname@example.org.
Financial Disclosure Dr. Walters is a consultant and speaker for American Medical Systems (Minnetonka, MN). Dr. Falcone has no potential conflicts of interest to disclose.