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Aroti Achari, MD
CHAPTER 32 Hysterectomy
❍ How many hysterectomies are done each year in the United States?
About 600,000 hysterectomies are performed annually in the United States, making hysterectomy the second
most-commonly performed operation for women of reproductive age in the United States, after cesarean delivery.
❍ What are the most common indications of hysterectomy?
From 2000 to 2004, approximately 3,100,000 hysterectomies were performed in the United States:
- 40.7% of them were done for symptomatic uterine fibroids.
- 17.7% for endometriosis.
- 14.5% for uterine prolapse.
❍ How do you determine the route and method of hysterectomy?
Safety and cost-effectiveness.
❍ What is the correct terminology regarding hysterectomy?
(1) Simple hysterectomy means removal of the uterus.
(2) Supracervical hysterectomy means removal of the uterine body while leaving the cervical portion of the uterus
in place.
(3) Total hysterectomy is the removal of the uterus as well as the cervix.
❍ Describe the various surgical approaches to hysterectomy.
(1) Abdominal hysterectomy is performed through an abdominal incision.
(2) Vaginal hysterectomy is performed through the vagina.
(3) Total laparoscopic hysterectomy is a hysterectomy where the uterosacral/cardinal ligaments are secured
laparoscopically and the cervix is completely freed from the vagina.
(4) Laparoscopic-assisted vaginal hysterectomy (LAVH) is a hysterectomy performed primarily via the vaginal
approach and the laparoscopic component is completed above the uterine vessels.
(5) Radical hysterectomy is the removal of the uterus, the upper 25% of the vagina, all of the uterovesical and
uterosacral ligaments, and the entire parametrium on either side, as well as pelvic lymph node dissection.
(6) Robotic-assisted hysterectomy is performed with the aid of the da Vinci robot system.