Abstract
Objective. To describe the route of hysterectomy in a county hospital and evaluate the shift towards a minimal invasive approach. Design. Retrospective cohort study. Setting. A county hospital in Norway. Population. All women were scheduled for hysterectomy. Methods. Audit the route of hysterectomy in the period 2004–2012. Analyze the outcome of total laparoscopic hysterectomies. Main Outcome Measures. Complications after total laparoscopic hysterectomy. Results. A shift towards a minimal invasive approach has been achieved during the study period. In 2012 only 17.4% of the hysterectomies were performed abdominally, compared to yearly percentages of above 50% in the period 2004–2009. Laparoscopic supracervical hysterectomy was introduced in 2003, but the percentage of abdominal hysterectomy remained above 50% until total laparoscopic hysterectomy was introduced in 2010. Since the introduction of total laparoscopic hysterectomy in April 2010, 58 procedures have been performed. There have been no major complications. Two vaginal vault hematomas and one case of urinary tract infection were reported. Conclusions. It is possible for a county hospital to alter their praxis and perform mini-invasive hysterectomies, but it requires dedicated gynecologists. This change to an advanced procedure like total laparoscopic hysterectomy could be achieved without patients suffering from major complications.
Highlights
There is convincing evidence that abdominal hysterectomy is associated with a less favourable outcome compared with a vaginal or laparoscopic approach
It is possible for a county hospital to alter their praxis and perform mini-invasive hysterectomies, but it requires dedicated gynecologists
This change to an advanced procedure like total laparoscopic hysterectomy could be achieved without patients suffering from major complications
Summary
There is convincing evidence that abdominal hysterectomy is associated with a less favourable outcome compared with a vaginal or laparoscopic approach. Hospitals with low patient volumes tended to perform more abdominal hysterectomies compared to larger hospitals. The percentage of abdominal hysterectomy was 100%, whereas in the largest hospital, the percentage of abdominal hysterectomy performed by laparotomy was about 20%. This indicates that techniques for minimal invasive hysterectomies have not yet been adapted by most gynecologists in smaller departments, the advantages and technique of such procedures have been frequently reported and described by colleagues from larger hospitals during the last decade
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