Hysterectomy Guidelines

Updated: May 03, 2021
  • Author: Hetal B Gor, MD, FACOG; Chief Editor: Michel E Rivlin, MD  more...
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Guidelines Summary

American College of Obstetricians and Gynecologists

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.

International Society for Gynecologic Endoscopy

In 2020, the International Society for Gynecologic Endoscopy (ISGE) published their recommendations for vaginal hysterectomy for a non-prolapsed uterus. [35]

Vaginal hysterectomy is the route preferred by the ISGE for the removal of a non-prolapsed uterus. The ISGE recommendations for the successful performance of this procedure are as follows:

  • A circular incision at the level of the cervicovaginal junction is recommended.
  • The posterior peritoneum should be opened first.
  • Clamping and cutting the uterosacral and cardinal ligaments before or after obtaining access into the anterior peritoneum is recommended.
  • Routine closure of the peritoneum during vaginal hysterectomy is not recommended.
  • Vertical or horizontal closure of the vaginal vault following vaginal hysterectomy is recommended.
  • The insertion of a vaginal plug after vaginal hysterectomy is not recommended.