Document Detail


Vaginal hysterectomy: dispelling the myths.
MedLine Citation:
PMID:  17493374     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Despite advances in minimally invasive surgery, most hysterectomies are still performed by laparotomy. The ratio of abdominal to vaginal hysterectomies ranges from 1:1 to 6:1 across North America, and in Canada is approximately 3:1. The SOGC clinical practice guideline on hysterectomy states that the vaginal route should be considered for every hysterectomy; if it is assumed that most surgeons would try to follow accepted guidelines, vaginal hysterectomy is presumably being considered and excluded. The evidence is compelling that vaginal hysterectomy is the approach of choice for benign pathology. The cited contraindications to vaginal hysterectomy are often unsubstantiated. In this commentary we examine the four reasons most often cited for avoiding a vaginal hysterectomy: (1) uterine size, (2) nulliparity and uterine descent, (3) need for oophorectomy, and (4) previous abdominopelvic surgery and extrauterine disease. More research is necessary to evaluate and demystify the barriers to performing minimally invasive hysterectomy. We recommend that preceptorship programs be developed for gynaecologic surgeons in an attempt to decrease the ratio of abdominal to vaginal hysterectomies.
Authors:
Geoff McCracken; Guylaine G Lefebvre
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC     Volume:  29     ISSN:  1701-2163     ISO Abbreviation:  J Obstet Gynaecol Can     Publication Date:  2007 May 
Date Detail:
Created Date:  2007-05-11     Completed Date:  2007-07-17     Revised Date:  2008-01-08    
Medline Journal Info:
Nlm Unique ID:  101126664     Medline TA:  J Obstet Gynaecol Can     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  424-8     Citation Subset:  IM    
Affiliation:
Department of Obstetrics and Gynecology, St. Michael's Hospital, Toronto ON.
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MeSH Terms
Descriptor/Qualifier:
Decision Support Techniques
Female
Humans
Hysterectomy, Vaginal / methods*
North America
Physician's Practice Patterns
Practice Guidelines as Topic
Societies, Medical
Surgical Procedures, Minimally Invasive / methods
Comments/Corrections
Comment In:
J Obstet Gynaecol Can. 2007 Oct;29(10):786; author reply 786   [PMID:  18050886 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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