Letter to the Editor

Promoting Awareness About Total Laparoscopic Hysterectomy

Authors: M. Sami Walid, MD, PhD, Richard L. Heaton, MD, FACOG


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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1. Merrill RM. Hysterectomy surveillance in the United States, 1997 through 2005. Med Sci Monit 2008;14:CR24–CR31.
2. David-Montefiore E, Rouzier R, Chapron C, et al.; Collegiale d'Obstétrique et Gynécologie de Paris-Ile de France. Surgical routes and complications of hysterectomy for benign disorders: a prospective observational study in French university hospitals. Hum Reprod 2007; 22:260–265.
3. Makinen J, Johansson J, Tomás C, et al. Morbidity of 10 110 hysterectomies by type of approach. Hum Reprod 2001;16:1473–1478.
4. Becker ER. National trends and determinants of hospitalization costs and lengths-of-stay for uterine fibroids procedures. J Health Care Finance 2007;33:1–16.
5. Walid MS, Heaton RL. Can laparoscopic hysterectomy replace abdominal hysterectomy in benign gynecological surgery? Presented at the ACOG 57th Annual Clinical Meeting. Chicago, IL, 2009.