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Evidence - Supracervical hysterectomy, bilateral salpingectomy, laparoscopic

  1. Indication

    Benign Conditions: Uterine fibroids (~50%), abnormal uterine bleeding (~40%), pain (e.g., in endometriosis/adenomyosis (~30%) or pelvic inflammatory diseases), uterine prolapse (~18%), 

    Malignant Conditions: Cervical, endometrial, ovarian cancer, and pre-invasive diseases.

    There are conservative and surgical alternatives to hysterectomy, depending on the underlying condition. For example, uterine fibroids can be treated with uterine artery embolization and myomectomy. Pelvic organ prolapse can be managed with conservative therapies such as pelvic floor exercises or pessaries. Chronic pelvic pain can be managed through pain control interventions, including hormonal therapy. Heavy menstrual bleeding can be treated with medical therapies, endometrial ablation, or intrauterine devices. Endometriosis and endometrial hyperplasia can often be treated medically, while cervical intraepithelial neoplasia may be adequately treated by conization. 

     

    Reference: 

    1. Whiteman MK, Hillis SD, Jamieson DJ, Morrow B, Podgornik MN, Brett KM, et al. Inpatient hysterectomy surveillance in the United States, 2000–2004. Am J Obstet Gynecol 2008;198:34.e1–7.
    2. Wright JD, Herzog TJ, Tsui J, Ananth CV, Lewin SN, Lu YS, et al. Nationwide trends in the performance of inpatient hysterectomy in the United States. Obstet Gynecol 2013;122:233–41.
    3. Merrill RM. Hysterectomy surveillance in the United States, 1997 through 2005. Med Sci Monit 2008; 14:CR24.
    4. Walker JL, Piedmonte MR, Spirtos NM, et al. Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group Study LAP2. J Clin Oncol 2009; 27:5331.
    5. Walker JL, Piedmonte MR, Spirtos NM, et al. Recurrence and survival after random assignment to laparoscopy versus laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group LAP2 Study. J Clin Oncol 2012; 30:695.
    6. Weber S, McCann CK, Boruta DM, et al. Laparoscopic surgical staging of early ovarian cancer. Rev Obstet Gynecol 2011; 4:117.
    7. Ramirez PT, Soliman PT, Schmeler KM, et al. Laparoscopic and robotic techniques for radical hysterectomy in patients with early-stage cervical cancer. Gynecol Oncol 2008; 110:S21.
Surgical access route

The choice of surgical approach depends on several factors, including the size and location of the

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