Attitudes to Mode of Hysterectomy—A Survey-Based Study Among Swedish Gynecologists

Abstract

Limited data are available on the attitudes of gynecologists regarding mode of hysterectomy for benign indications. This cross-sectional study used a postal questionnaire to assess attitudes of members of the Swedish Society of Obstetrics and Gynecology toward mode of benign hysterectomy. The choices of mode of hysterectomy were total abdominal hysterectomy, subtotal abdominal hysterectomy, laparoscopic or laparoscopically-assisted hysterectomy, and vaginal hysterectomy (VH). Participants were asked questions about their gender, seniority, place of work, and surgical experience, including years in the specialty and annual number of hysterectomies performed to determine whether differences in such factors influenced their choice of mode. The gynecologists were asked to choose between these modes for 3 scenarios with different benign clinical conditions. Scenario A was a normal to slightly enlarged uterus with no uterine descensus and no previous cervical dysplasia. Scenario B differed from the first scenario only in that there had been previous treatment of cervical dysplasia up to moderate degree (CIN II). In scenario C, there was an enlarged uterus (larger than gestational week 12―13) with no uterine descensus and no previous cervical dysplasia. The respondents were also asked to give their personal view of how the overall distribution should be for the different modes of benign hysterectomy. Multiple logistic regression and multivariate models of covariance were used for unadjusted and adjusted analyses. The participants chose VH in general or when the uterus was of normal size or slightly enlarged (scenarios A and B), and recommended abdominal hysterectomy and subtotal abdominal hysterectomy when the uterus was enlarged (scenario C). More male gynecologists than female gynecologists favored VH as a personal preference. There were significant variations in choice and suggested distribution of mode for place of work, seniority, and annual number of hysterectomies performed. More than 50% of the participants recommended the minimally-invasive methods of vaginal and laparoscopic hysterectomy as their overall personal choice for suggested distribution. These findings indicate that choice of mode of hysterectomy for benign conditions among gynecologists is significantly influenced by personal preference based on differences in gender, place of work, seniority, and annual number of hysterectomies, and does not appear to strictly follow evidence-based recommendations.