Sun beams on hysterectomies

Abstract

Are hysterectomies still necessary in 2010 and why and how should they be performed? As every now and then a critical evaluation of routine surgical procedure is necessary, there it is: This review follows the “Perspectives on laparoscopic hysterectomy” by Michelle Nisolle (Gynecol Surg 7:105–107, 2010). Hysterectomies performed in the field of obstetrics and gynaecology until the nineteenth century had always a lethal end. In the twentieth century, they were perhaps too frequently performed whereas the twenty-first century has witnessed a steep decline in hysterectomy numbers. It is therefore an opportune time to review the indications for hysterectomies, hysterectomy techniques and the present and future status of this surgical procedure. There is a widespread consensus that hysterectomies are primarily to be performed in cancer cases and obstetrical chaos situations even though minimal invasive surgical technologies have made the procedure more patient-friendly than the classical abdominal opening. Today, minimally invasive hysterectomies are performed as frequently as vaginal hysterectomies, and the vaginal approach is still the first choice if the correct indications are given. It is no longer necessary to open the abdomen; this procedure has been replaced by laparoscopic surgery with multiple and single port entries. Laparoscopic and robotic-assisted laparoscopic surgery can also be indicated for hysterectomies in selected patients with gynaecological cancers. For women of reproductive age, laparoscopic myomectomies and numerous other uterine-preserving techniques are applied in a first treatment step of menometrorrhagia, uterine adenomyosis and submucous myoma. These interventions are only followed by a hysterectomy if the pathology prevails.