Letter to the Editor
Promoting Awareness About Total Laparoscopic Hysterectomy
Abstract
To the Editor:
Hysterectomy is a major gynecological procedure with roughly 600,000 operations performed every year in the United States. It is a surgical operation surrounded by controversy due to the considerable cost inflicted on patients, insurance companies, and the society at large. The United States has one of the highest rates of hysterectomy in the world. By age 60, over a third of all US women would have had hysterectomy versus a fifth of Canadian or UK women. Total laparoscopic hysterectomy (TLH) and laparoscopically-assisted vaginal hysterectomy (LAVH) have been increasingly used for benign indications; however, they are still not widespread and are less used by gynecologists than the total abdominal hysterectomy (TAH) and total vaginal hysterectomy (TVH) routes due to lack of experience and groundless fear of complications. The ratio of abdominal to vaginal hysterectomies in the United States is approximately 2:1.1 In France, TVH is the route of choice for benign pathology. Hysterectomy is performed by the TLH, LAVH, TAH, and TVH in 19%, 8%, 24% and 48% of cases, respectively.2 The situation in Scandinavian countries is somewhat better laparoscopically. In Finland, laparoscopic hysterectomy accounts for 24% of the operations, vaginal for 18%, and abdominal for 58% (2000).3
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