Hysterectomy is a common operation. Vaginal hysterectomy is the recommended route because there are fewer complications, shorter hospitalization, less hospital costs, and better quality of life outcomes over either abdominal hysterectomy (AH) or laparoscopic hysterectomy. We evaluated the proportion of different routes of hysterectomies performed in a tertiary hospital during a 12-month period.
A retrospective chart review was conducted of all hysterectomies performed from January 1, 2004 to December 31, 2004 at a university-affiliated tertiary gynecology center. We tested the agreement between actual hysterectomy types and recommended the approach for hysterectomy based on 4 different treatment algorithms, using McNemar's test for paired proportions. A κ-statistic was also generated for each of the comparisons.
A total of 275 patients with benign gynecologic indications for hysterectomy were identified. As many as 10%, 55%, 74%, and 81% of AHs could have been performed with a minimally invasive technique, based on algorithms 1 to 4. The κ value for each algorithm was 0.3452, 0.3136, 0.1160, and 0.0985, respectively.
The advantages of a minimally invasive approach are no longer questioned. Our study reveals that gynecologists with advanced surgical training had significantly higher rates of minimally invasive hysterectomies. Our challenge now is how do we increase the ratio of minimally invasive hysterectomies to AH? In particular, how do we increase the rate of vaginal hysterectomies?