What are different approaches for hysterectomy? Is one method superior to the other ones?
Hysterectomy which means removal of the uterus with/without cervix can be done with different approaches. It can be done through the vaginal approach (vaginal hysterectomy), using laparoscopic approach ( Laparoscopic hysterectomy) or with the use of da Vinci ® robot( robotic hysterectomy). These are all minimally invasive methods with the advantages of rapid healing, minimal blood loss, lower infection rates,…
Hysterectomy can also be done by making an abdominal incision (abdominal hysterectomy). With the advancement of minimally invasive approaches, abdominal hysterectomy has become less common.
There are different reasons for hysterectomy which include malignancy, benign fibroid tumors, heavy bleeding, pelvic pain and ultimately prolapsed uterus.
The best approach depends on the reason for hysterectomy, specific findings during examination, such as size of the uterus, size and shape of pelvis, degree of prolapse and many other patients’ specific characteristics.
Vaginal hysterectomy (such as vNOTES) has the advantage of doing the task through vagina without making any incision in the abdomen, therefore, it has cosmetic benefits. On the other hand, laparoscopic and robotic approach allow better visualization of abdominal cavity. This can be particularly helpful in identifying pathologies such as endometriosis. Easier access to ovaries also can be considered as advantage of laparoscopic or robotic approach.
The complication rates of hysterectomy such as injury to the bladder, ureters and bowels, blood loss and infection have been compared in different approaches but overall, all of these minimally invasive methods have the advantage of low risks of complications.
No need to say that experience of the surgeon to do the hysterectomy with each method is a key factor for success.