Most hysterectomies still invasive procedures

NEW YORK (Reuters Health) - Most women in the United States who undergo a hysterectomy for a noncancerous condition will have surgery with the traditional, “open” abdominal method, which is more invasive and requires a longer recovery than hysterectomies performed with laparoscopic or vaginal techniques, according to a report in the medical journal Obstetrics & Gynecology.

Although the rates of laparoscopic hysterectomy have increased and now reach 11.8 percent, laparoscopic and vaginal hysterectomies remain far less common than abdominal hysterectomies, Dr. Jennifer M. Wu from Duke University, Durham, North Carolina, told Reuters Health.

Wu and colleagues investigated national hysterectomy rates by type of procedure and compared patient age, length of stay, and regional variation in the type of hysterectomy performed in women with benign disease.

Of more than 538,000 hysterectomies performed for benign disease in 2003, 66.1 percent were abdominal hysterectomies, in a large abdominal incision is made to remove the uterus. Another 21.8 percent were vaginal, in which the uterus is extracted entirely through the vagina, leaving no scars. And finally, 11.8 percent done by laparoscopy, which is conducted by inserting one or more small plastic tubes through tiny incisions made in the abdominal wall, allowing narrow surgical instruments and a tiny camera to pass through to remove the uterus.

The hysterectomy rate of 5.38 per 1,000 women per year was similar to rates from the previous decade, the investigators note, but the proportion of laparoscopic procedures increased significantly from 0.3 percent in 1990.

Hysterectomy rates were highest in the South and lowest in the North, but the percentage of laparoscopic procedures was similar across all regions.

Hospitalization was shorter after laparoscopic hysterectomy, at 1.7 days, than after vaginal or abdominal hysterectomy, at 2.0 days and 3.0 days, respectively, the report indicates.

The most common reason for abdominal hysterectomy was fibroid tumors, whereas prolapse (protrusion of the uterus into the birth canal) was the most common reason for a vaginal hysterectomy, the researchers note. Laparoscopic hysterectomy was conducted for a variety of conditions.

The best route of hysterectomy depends on a number of factors, such as the reason for surgery, patient characteristics (body mass index, previous surgeries), other procedures being performed, the surgeon’s experience, length of stay, and other variables, Wu said.

Overall, “the route of surgery should be individualized to the patient,” she added.

“Having said that, it is generally accepted that vaginal hysterectomy is associated with the lowest morbidity so the surgery of choice is vaginal hysterectomy over a laparoscopic or abdominal approach,” Wu explained.

“The decision between laparoscopic versus abdominal should take into account the above-mentioned factors to determine what route of surgery should be pursued for each particular patient.”

“While laparoscopic surgery is associated with shorter length of stay, faster recovery and fewer postoperative infections compared to abdominal hysterectomy, it requires specialized training and potentially longer operating room times,” Wu added. “Thus, it will be interesting to see whether the rate of laparoscopic hysterectomy continues to increase.”

SOURCE: Obstetrics & Gynecology, November 2007.