The Decline of the Preferred Approach to Hysterectomy


Vaginal hysterectomies are associated with superior patient outcomes and cost less than other methods of hysterectomy. So why is their rate of use declining?

Whether you believe that hysterectomies are an important avenue of treatment for multiple conditions or whether you believe that hysterectomies are overutilized, the fact remains that one method of hysterectomy continues to be the most recommended-the vaginal approach. However, despite its status as the approach of preference, the use of vaginal hysterectomies is declining.

During the Donald F. Richardson Memorial Lecture today at the 2014 ACOG Annual Clinical Meeting in Chicago, Rosanne M. Kho, MD, associate professor at the College of Medicine, Mayo Clinic and consultant to the Mayo Clinic’s Department of Obstetrics and Gynecology’s Division of Pelvic Reconstructive Surgery in Scottsdale, Arizona, discussed the importance of increasing the rate of vaginal hysterectomy by facilitating vaginal surgery with surgical innovation and techniques.

According to data presented during the lecture, the percentage of hysterectomies performed vaginally declined from 22% in 2007 to 20% in 2010. During this same period, the abdominal approach decreased as well, from 50% to 40%, respectively. However, the percentage of hysterectomies performed laparoscopically increased from 24% in 2007 to 30% in 2010, and the percentage of robotic methods of hysterectomy increased from essentially zero to 10%, respectively.

Practicing gynecologists are choosing to perform hysterectomy laparoscopically or use robotic methods, said Kho. In addition, ob/gyns residents are completing their training programs with less experience in vaginal hysterectomies than in minimally invasive methods.

Yet the vaginal approach remains the preferred approach to benign hysterectomy, according to available study data, because of superior patient outcomes as well as because it’s the most cost-effective method when compared with abdominal, laparoscopic, and robotic approaches, Kho explained.

“In this time of cost-containment, I think it’s even more relevant to perform the hysterectomy vaginally,” she said.

What is your preferred approach to benign hysterectomy and, if not a vaginal approach, why?

To answer this question and share your thoughts, just comment in the box below.

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