WebMD Medical News
Laura J. Martin, MD
Nov. 9, 2010 -- Two-thirds of hysterectomies performed in the United States involve abdominal surgery, even though there is a growing consensus that less invasive procedures are generally safer with quicker recovery times.
In a position paper released this week, the American Association of Gynecologic Laparoscopists (AAGL) concluded that abdominal surgery generally should be avoided when the uterus is removed for conditions unrelated to cancer.
“It is the position of the AAGL that in most hysterectomies for benign disease should be performed either vaginally or laparoscopically and that continued efforts should be taken to facilitate these approaches,” the statement reads.
Last fall, the nation’s largest group of gynecologists also weighed in on the issue. A committee of the American College of Obstetricians and Gynecologists (ACOG) concluded that vaginal hysterectomy is associated with better outcomes and fewer complications than either abdominal or laparoscopic hysterectomy.
AAGL Medical Director Franklin D. Loffer, MD, says too few ob-gyns are trained to perform minimally invasive hysterectomies.
“One reason so many abdominal procedures are performed is that many gynecologists do not feel comfortable doing vaginal or laparoscopic hysterectomies,” he tells WebMD.
About 600,000 hysterectomies are performed each year in the U.S., with the most common reason for the removal of the uterus being fibroids, followed by endometriosis and uterine prolapse.
Abdominal hysterectomy requires a relatively large incision, while the laparoscopic procedure requires much smaller cuts. As the name implies, with vaginal hysterectomy the uterus is removed through a small incision in the vagina.
Even uncomplicated abdominal hysterectomies require hospitals stays of several days, but the less invasive procedures can often be performed on an outpatient basis. Recovery times also tend to be much shorter and the overall costs of vaginal or laparoscopic hysterectomies tend to be lower.
Laparoscopic hysterectomy has generally been considered to be a poor choice for patients who have had C-sections and for those who are obese, but the AAGL found these to be without merit.
The group concluded that the minimally invasive approaches are preferable to abdominal hysterectomy in most cases.
Exceptions include women with known or suspected malignancies, those with certain uterine diseases, and those who lack access to practitioners trained in the minimally invasive procedures.
Cheryl Iglesia, MD, who chairs the ACOG Committee on Gynecologic Practices, says too many abdominal surgeries are performed in the United States.
Iglesia directs the female pelvic medicine division of the Washington Hospital Center in Washington, D.C. She is also an associate professor of obstetrics and gynecology at Georgetown University.
She says women facing hysterectomies for non-cancer-related causes should be told about minimally invasive options as well as nonsurgical treatment alternatives.
“Most women have options, so it is important to explore them,” she tells WebMD. “If someone is given just one way to treat their condition, it’s time to seek a second opinion.”
The AAGL represents more than 5,000 gynecologic surgeons across the U.S.
SOURCES:AAGL position statement, Journal of Minimally Invasive Gynecology, published online Nov. 8, 2010.Franklin D. Loffer, MD, executive vice president/medical director, American Association of Gynecologic Laparoscopists.Cheryl B. Iglesia, MD, chairperson, ACOG Committee on Gynecologic Practice; director, division of Female Pelvic Medicine and Reconstructive Surgery, Washington Hospital Center, Washington, D.C.; associate professor of ob-gyn, Georgetown University Medical Center, Washington, D.C.News release, Levier Publications.American College of Obstetricians and Gynecologists: "ACOG Recommends Vaginal Hysterectomy as Approach of Choice."Womenshealth.gov: "Hysterectomy."Merrill, R. Medical Science Monitor, 2008.
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