Abstract
Background: When choosing a surgical procedure for a hysterectomy, doctors and patients have various options in terms of the multiple surgical access points available. The aim of this study was to descriptively analyze developments concerning the surgical access point selected over the past 10 years at Ulm University Hospital, (south) Germany, assess the variables associated with the surgical method and explore any potential significant correlations that influence these surgical access routes. Explicitly, we wished to investigate whether the approval of ulipristal acetate and the warning issued by the Food and Drug Administration (FDA) in connection with its use changed existing trends.Material and Methods: This monocentric study retrospectively assessed data from all patients who underwent a hysterectomy due to a benign disease or endometrial cancer from January 2007 until December 2016.Results: Of the benign indications considered, myomas and descensus genitalis occurred most frequently (49.5 and 30.6%, respectively). The percentage of abdominal procedures declined from 61.4 to 13.4% between 2007 and 2016 for all hysterectomies, whilst it increased from 4.1 to 69.7% for laparoscopic hysterectomies. The rate of vaginal hysterectomies increased to 45.5% until 2013 and declined in the years afterwards. Laparoscopic assisted vaginal hysterectomies were comparatively rare.The trends in terms of surgical routes were similar for endometrial cancer. During the observation period, the share of abdominal hysterectomies fell from 100 to 11.3%, whilst the share of laparoscopic hysterectomies increased from 0 to 86.6%. The other two procedures were less frequently used.Use of the laparoscopic hysterectomy procedure also increased significantly after the FDA's 2014 warning. Ulipristal acetate may have tended to influence the process.Conclusion: Contrary to the national decrease in hysterectomy numbers, the annual number of hysterectomies at Ulm University Hospital remained stable during the observation period. Nevertheless, there was a clear shift in the preferred surgical routes for hysterectomy.
Highlights
A hysterectomy is the second most frequent surgical procedure in the field of gynecology after a Cesarean section [1, 2]
111,673 hysterectomies were conducted in Germany in 2016 [2], which represents a decline of nearly 45,000 hysterectomies compared to 2007 [5]
Whilst this had a major impact on the surgical route in the USA, this has not been reflected in the numbers for European hospitals
Summary
A hysterectomy (removal of the uterus) is the second most frequent surgical procedure in the field of gynecology after a Cesarean section [1, 2]. There are multiple surgical methods for removing the uterus, allowing surgeons to select the procedure and access route that best suit the individual patient based on their general state of health. In March 2012, ulipristal acetate was approved in Germany with the aim of reducing the growth of benign tumors followed by an FDA warning on power morcellation in 2014 [9]. Whilst this had a major impact on the surgical route in the USA, this has not been reflected in the numbers for European hospitals. We wished to investigate whether the approval of ulipristal acetate and the warning issued by the Food and Drug Administration (FDA) in connection with its use changed existing trends
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