Most hysterectomies for benign conditions should be performed either vaginally or laparoscopically, not abdominally -- that is, by cutting through the stomach wall -- the AAGL said in a position statement published Monday in the Journal of Minimally Invasive Gynecology. Admittedly, the AAGL, formerly known as the American Assn. of Gynecologic Laparoscopists, has a bit of an axe to grind, as laparoscopic and vaginal surgery are their bread and butter. But a growing body of scientific evidence suggests that those two approaches provide a much better way to approach the problem of hysterectomies. Typically, patients spend no more than one night in the hospital and, in many cases, the procedure is performed on an outpatient basis. The chances of infection resulting from the surgery are much smaller, and costs are much lower, about half as much -- a major consideration in times of growing healthcare costs.
About 600,000 hysterectomies are performed in the United States each year for benign conditions, and about two-thirds of them are still performed abdominally, according to the AAGL. That contrasts with countries like Denmark, where up to three-quarters of the surgeries are performed in a minimally invasive manner with no increase in complications, the group said.
There are, however, certain exceptions, according to the statement. Laparoscopic hysterectomy should not be performed when the patient has a disease, such as cardiopulmonary disease, in which the increased intraperitoneal pressure associated with the procedure cannot be tolerated, or when the presence of a tumor is suspected. Neither procedure is appropriate when there is no access to the surgeons or facilities required and referral is not feasible or when the anatomy is sufficienty deformed by vaginal disease that the laparoscopic approach is not deemed safe or reasonable.