Preferred and actual methods of hysterectomy: A survey of current practices among members of the South African Society of Obstetricians and Gynaecologists

Abstract

Background. Hysterectomy remains one of the most common operative procedures for benign uterine diseases. Total abdominal hysterectomy (TAH) constitutes the most common approach despite the advantages of minimally invasive hysterectomy (MIH). Objectives. To explore the current opinion on hysterectomy choices amongst members of the South African Society of Obstetricians and Gynaecologists (SASOG), as well as the perceptions and potential barriers that may inhibit gynaecologists from offering MIH to their patients. Methodology. An anonymous survey designed to explore the preferences of practising obstetrician gynaecologists regarding the optimal hysterectomy procedure, and perceived barriers towards MIH. Results. The average age of the respondents ( N =152) was 45.7 years, with 88.2% having >5 years’ experience in private practice. When asked about the preferred route of hysterectomy for themselves or their relatives, 46.2% chose vaginal hysterectomy (VH), 25.4% chose total laparoscopic hysterectomy (TLH), 15% chose laparoscopic assisted vaginal hysterectomy (LAVH) and 8.5% chose TAH. However, the most commonly performed hysterectomy procedure undertaken by the respondents in the last year was TAH. Only half of the respondents wished to increase their rate of VH and a lesser number to extend their laparoscopic hysterectomy rates. Conclusion. Although the majority of the respondents preferred the minimally-invasive VH or TLH for themselves or their relatives, TAH remains the most common hysterectomy method among SA gynaecologists. This difference could present an ethical dilemma for the gynaecologist. The desire of a minority to change their approach to VH indicates the difficulty in changing attitudes and the need to promote VH as a technique within SASOG.