Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-745bb68f8f-5r2nc Total loading time: 0 Render date: 2025-01-12T10:42:07.136Z Has data issue: false hasContentIssue false

Chapter 49 - Hysterectomy for Benign Conditions

from Section 10 - Operative Gynaecology

Published online by Cambridge University Press:  24 November 2021

By
Thomas Vrekoussis ,
Iordanis Navrozoglou  and
Antonis Makrigiannakis
Edited by
Tahir Mahmood ,
Charles Savona-Ventura ,
Ioannis Messinis  and
Sambit Mukhopadhyay
Tahir Mahmood
Affiliation:
Victoria Hospital, Kirkcaldy
Charles Savona-Ventura
Affiliation:
University of Malta, Malta
Ioannis Messinis
Affiliation:
University of Thessaly, Greece
Sambit Mukhopadhyay
Affiliation:
Norfolk & Norwich University Hospital, UK
Get access

Summary

Despite the efforts for conservative treatment for several benign entities, hysterectomy is the therapeutic cornerstone. The current chapter presents an overview of the surgical techniques, as these are applied via different surgical approaches: abdominal, vaginal and minimal access. Special emphasis is given to the potential complications encountered during the postoperative period. Several issues of controversy are also discussed and suggestions have been made according to the current guidelines. It is evident that hysterectomy should always be included in a training curriculum with the surgical skill being maintained via a minimum number of procedures performed yearly. Route selection is very important in reducing possible complications. In the same direction, whenever possible, an enhanced patient recovery scheme should be applied.

Keywords

hysterectomyabdominalvaginallaparoscopicsubtotal
Type
Chapter
Information
The EBCOG Postgraduate Textbook of Obstetrics & Gynaecology
Gynaecology
 , pp. 432 - 436
Publisher: Cambridge University Press
Print publication year: 2021

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Falcone, T, Walters, MD. Hysterectomy for benign disease. Obstet Gynecol 2008;111:753–767.CrossRefGoogle ScholarPubMed
Neis, KJ, Zubke, W, Fehr, M, et al. Hysterectomy for benign uterine disease. Dtsch Arztebl Int 2016;113:242–249.Google Scholar
Moen, M. Hysterectomy for benign conditions of the uterus: total abdominal hysterectomy. Obstet Gynecol Clin North Am 2016;43:431–440.Google Scholar
Seiler, CM, Deckert, A, Diener, MK, et al. Midline versus transverse incision in major abdominal surgery: a randomized, double-blind equivalence trial (POVATI: ISRCTN60734227). Ann Surg 2009;249: 913–920.Google Scholar
Barr, J, Brayman, KL. Development and evolution of self-retaining retractors in surgery: the example of the Bookwalter retractor. J Am Coll Surg 2015;221:628–634.Google Scholar
Byrnes, JN, Occhino, JA. Hysterectomy for benign conditions of the uterus: total vaginal hysterectomy. Obstet Gynecol Clin North Am 2016;43:441–462.Google Scholar
Committee on Gynecologic Practice. Committee opinion No 701: choosing the route of hysterectomy for benign disease. Obstet Gynecol 2017;129:e155–e159.Google Scholar
Neis, KJ, Zubke, W, Romer, T, et al. Indications and route of hysterectomy for benign diseases: guideline of the DGGG, OEGGG and SGGG (S3 Level, AWMF Registry No. 015/070, April 2015). Geburtshilfe Frauenheilkd 2016;76:350–364.Google Scholar
Clarke-Pearson, DL, Geller, EJ. Complications of hysterectomy. Obstet Gynecol 2013;121:654–673.CrossRefGoogle ScholarPubMed
Niblock, K, Bailie, E, McCracken, G, Johnston, K. Vaginal McCall culdoplasty versus laparoscopic uterosacral plication to prophylactically address vaginal vault prolapse. Gynecol Surg 2017;14:3.CrossRefGoogle ScholarPubMed
King, CR, Giles, D. Total laparoscopic hysterectomy and laparoscopic-assisted vaginal hysterectomy. Obstet Gynecol Clin North Am 2016;43:463–478.CrossRefGoogle ScholarPubMed
Simpson, KM, Advincula, AP. The essential elements of a robotic-assisted laparoscopic hysterectomy. Obstet Gynecol Clin North Am 2016;43: 479–493.CrossRefGoogle ScholarPubMed
Ramdhan, RC, Loukas, M, Tubbs, RS. Anatomical complications of hysterectomy: a review. Clin Anat 2017;30: 946–952.CrossRefGoogle ScholarPubMed
Lonky, NM, Mohan, Y, Chiu, VY, et al. Hysterectomy for benign conditions: complications relative to surgical approach and other variables that lead to post-operative readmission within 90 days of surgery. Womens Health (Lond) 2017;13:17–26.CrossRefGoogle ScholarPubMed
Mytton, J, Evison, F, Chilton, PJ, Lilford, RJ. Removal of all ovarian tissue versus conserving ovarian tissue at time of hysterectomy in premenopausal patients with benign disease: study using routine data and data linkage. BMJ 2017;356:j372.CrossRefGoogle ScholarPubMed
Evans, EC, Matteson, KA, Orejuela, FJ, et al. Salpingo-oophorectomy at the time of benign hysterectomy: a systematic review. Obstet Gynecol 2016;128:476–485.CrossRefGoogle ScholarPubMed
Adelman, MR, Sharp, HT. Ovarian conservation vs removal at the time of benign hysterectomy. Am J Obstet Gynecol 2018;218:269–279.Google Scholar
Salvador, S, Scott, S, Francis, JA, Agrawal, A, Giede, C. No. 344: opportunistic salpingectomy and other methods of risk reduction for ovarian/fallopian tube/peritoneal cancer in the general population. J Obstet Gynaecol Can 2017;39:480–493.CrossRefGoogle ScholarPubMed
Hanley, GE, McAlpine, JN, Kwon, JS, Mitchell, G. Opportunistic salpingectomy for ovarian cancer prevention. Gynecol Oncol Res Pract 2015;2:5.CrossRefGoogle ScholarPubMed
Kho, RM, Magrina, JF. Removal of the retained cervical stump after supracervical hysterectomy. Best Pract Res Clin Obstet Gynaecol 2011;25: 153–156.Google Scholar
Andersen, LL, Ottesen, B, Alling Moller, LM, et al. Subtotal versus total abdominal hysterectomy: randomized clinical trial with 14-year questionnaire follow-up. Am J Obstet Gynecol 2015;212:758.e1–758.e54.CrossRefGoogle ScholarPubMed
Andersen, LL, Zobbe, V, Ottesen, B, et al. Five-year follow up of a randomised controlled trial comparing subtotal with total abdominal hysterectomy. BJOG 2015;122:851–857Google Scholar
Sandberg, EM, Hehenkamp, WJK, Geomini, PM, et al. Laparoscopic hysterectomy for benign indications: clinical practice guideline. Arch Gynecol Obstet 2017;296: 597–606.Google Scholar
Bassetti, M, Righi, E, Astilean, A, et al. Antimicrobial prophylaxis in minor and major surgery. Minerva Anestesiol 2015;81: 76–91.Google Scholar
Ayeleke, RO, Mourad, S, Marjoribanks, J, Calis, KA, Jordan, V. Antibiotic prophylaxis for elective hysterectomy. Cochrane Database Syst Rev 2017;6:CD004637.Google Scholar
Kahr, HS, Thorlacius-Ussing, O, Christiansen, OB, et al. Venous thromboembolic complications to hysterectomy for benign disease: a nationwide cohort study. J Minim Invasive Gynecol 2018;25:715–723.e2.Google Scholar
Brummer, TH, Heikkinen, A, Jalkanen, J, et al. Pharmaceutical thrombosis prophylaxis, bleeding complications and thromboembolism in a national cohort of hysterectomy for benign disease. Hum Reprod 2012;27:1628–1636.CrossRefGoogle Scholar
Felder, S, Rasmussen, MS, King, R, et al. Prolonged thromboprophylaxis with low molecular weight heparin for abdominal or pelvic surgery. Cochrane Database Syst Rev 2018;11:CD004318.Google ScholarPubMed
Deffieux, X, Rochambeau, B, Chene, G, et al. Hysterectomy for benign disease: clinical practice guidelines from the French College of Obstetrics and Gynecology. Eur J Obstet Gynecol Reprod Biol 2016;202:83–91.Google Scholar
Aarts, JW, Nieboer, TE, Johnson, N, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev 2015;8:CD003677Google Scholar
Sandberg, EM, Twijnstra, ARH, Driessen, SRC, Jansen, FW. Total laparoscopic hysterectomy versus vaginal hysterectomy: a systematic review and meta-analysis. J Minim Invasive Gynecol 2017;24:206–217.e22.CrossRefGoogle ScholarPubMed
Schmitt, JJ, Carranza Leon, DA, Occhino, JA, et al. Determining optimal route of hysterectomy for benign indications: clinical decision tree algorithm. Obstet Gynecol 2017;129: 130–138.CrossRefGoogle ScholarPubMed
ACOG. Committee opinion no. 750: perioperative pathways: enhanced recovery after surgery. Obstet Gynecol 2018;132:e120–e132.CrossRefGoogle Scholar
Kalogera, E, Dowdy, SC. Enhanced recovery pathway in gynecologic surgery: improving outcomes through evidence-based medicine. Obstet Gynecol Clin North Am 2016;43:551–573.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×