Vaginal or Laparoscopic Hysterectomies Most Recommended

The American Association of Gynecologic Laparoscopists (AAGL; Cypress, CA, USA), a medical specialty society of over 5,000 gynecologic surgeons, advocates the practice of performing vaginal hysterectomy (VH) and laparoscopic hysterectomy (LH) in a minimally invasive manner, thus reducing morbidity and facilitating a faster recovery period.

In an evidence-based position statement, the AAGL states that hysterectomies performed vaginally or laparoscopically are associated with low surgical risks, and can be performed with a short hospital stay or in many instances as an outpatient procedure. The position statement also asserts that clinical situations once considered as contraindications to LH, such as obesity and a previous cesarean section, have been found to have a safety and efficacy profile that is similar for both obese and non-obese patients. Surgeons without the requisite training and skills required for the safe performance of VH or LH are urged to enlist the aid of colleagues who do, or should refer patients requiring hysterectomy to such individuals for their surgical care. The position statement was published ahead of print on November 17, 2010, in the Journal of Minimally Invasive Gynecology.

"When procedures are required to treat gynecologic disorders, the AAGL is committed to the principles of informed patient choice and provision of minimally invasive options,” said Franklin D. Loffer, M.D., the executive vice president and medical director of the AAGL. "When hysterectomy is necessary, the demonstrated safety, efficacy, and cost-effectiveness of VH and LH mandate that they be the procedures of choice. When hysterectomy is performed without a laparotomy, early institutional discharge is feasible and safe, in many cases within the first 24 hours.”

Currently, almost two-thirds of the approximately 600,000 procedures performed in the United States annually to treat benign disorders of the pelvis are performed via an abdominal hysterectomy (AH), which requires a relatively large abdominal incision and is associated with a number of disadvantages, largely related to abdominal wound infections, relatively prolonged institutional stay, and delayed return to normal activities.

Related Links:
American Association of Gynecologic Laparoscopists