What is the clinically appropriate route and method for hysterectomy in a given patient? Is this really a difficult question? Surprisingly, the delivery of healthcare services for hysterectomy varies both from community to community and from physician to physician. The numbers of hysterectomies performed have long been a concern; now the type of surgical route is being subjected to more careful scrutiny. For most of the 20th century, abdominal hysterectomy has been the preferred route by a 3 to 1 ratio compared to vaginal hysterectomy. It can be argued that during this time many contraindications to the vaginal route were accepted as absolute by US surgeons who were frequently only taught the abdominal route. When competition between these two types of hysterectomy emerged, it was suggested that the routes were performed for different indications. This was never substantiated and in the year 2000, it was documented that not only abdominal and vaginal but also total laparoscopic and robotic hysterectomies were all performed for similar indications.
Robert Kovac S (2013) Evidence-Based Hysterectomy. Gynecol Obstet 3:e110. doi: 10.4172/2161-0932.1000e110