Hysterectomy Guidelines

Updated: Apr 12, 2018
  • Author: Hetal B Gor, MD, FACOG; Chief Editor: Michel E Rivlin, MD  more...
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Guidelines Summary

The American College of Obstetricians and Gynecologists made the following recommendations on choosing the route of hysterectomy for benign disease [34] :

  • Vaginal hysterectomy is the approach of choice whenever feasible.
  • Laparoscopic hysterectomy is a preferable alternative to open abdominal hysterectomy for those patients in whom a vaginal hysterectomy is not indicated or feasible.
  • The surgeon should account for clinical factors to determine the best route of hysterectomy for each individual patient.
  • The size and shape of the vagina and uterus; accessibility to the uterus (eg, descensus, pelvic adhesions); extent of extrauterine disease; the need for concurrent procedures; surgeon training and experience; average case volume; available hospital technology, devices, and support; whether the case is emergent or scheduled, and patient preference can all influence the route of hysterectomy.
  • A discussion with the patient should take place on the route of hysterectomy and advantages and disadvantages of each approach.
  • Opportunistic salpingectomy usually can be safely accomplished at the time of vaginal hysterectomy.
  • The role of robotic assistance for execution of laparoscopic hysterectomy has not been clearly determined and more studies are needed to determine clinical use.