Hysterectomy for Benign Disease

Abstract

The number of hysterectomies performed is decreasing because of the availability of less-invasive alternatives and a general trend towards more conservative management. Historically, hysterectomy was performed through the vagina, which is the preferred approach. Nonetheless, a laparoscopic approach can be used to avoid open surgery when the vaginal route is not feasible. Total hysterectomy should be performed and intrafascial hysterectomy may have some advantage over extrafascial hysterectomy. The age of the patient, risk of ovarian carcinoma, and risk of reoperation should be considered prior to performing prophylactic salpingo-oophorectomy. Salpingectomy should be discussed with the patient who wishes to conserve her ovaries. There is now a trend towards shorter hospital stay and same-day discharge following hysterectomy. Criteria for audit on the operations are suggested.