Université Paris Descartes, Sorbone Paris Cité, Faculté de Médecine, Assistance Publique – Hôpitaux de Paris (AP- HP), Groupe Hospitalier Universitaire (GHU) Ouest, Centre Hospitalier Universitaire (CHU) Cochin, Department of Gynecology Obstetrics II and Reproductive Medicine (Professor Chapron), Paris, France.
Hysterectomy is actually considered one of the most common major surgical procedures performed in women. An estimated half million hysterectomy procedures are performed each year in the United States. The majority of cases are performed for benign gynecologic conditions, including uterine leiomyomata, endometriosis, abnormal menstrual bleeding, and pelvic organ prolapse accounting for more than 90% of all hysterectomies; malignant disease, such as uterine cancer, cervical cancer, and ovarian cancer, account for the remaining 10%.
The first case of laparoscopic- assisted hysterectomy was published by Reich and colleagues in 1989. Since that time, trends have changed as the proportion of laparoscopic approaches to hysterectomy have increased throughout the world while abdominal hysterectomies have decreased. Minimally invasive surgery (MIS) approaches–including laparoscopic hysterectomy, vaginal hysterectomy, and robotic-assisted hysterectomy are becoming increasingly common as compared to abdominal hysterectomy even for complex cases, which is supported by improvements in surgical equipment and emerging developments in specialized training programs.
More clearly compared with abdominal laparotomy, utilization of minimally invasive surgeries is preferred as they result in decreased medical and surgical perioperative complications, shorter hospital stays, faster return to normal activities, improved patient quality of life and lowers health care costs.
Hysterectomy may also include a bilateral oophorectomy. The proportion of women undergoing bilateral oophorectomy concomitant with hysterectomy differs among countries and increases by age in most countries. In addition the percentage of subtotal hysterectomies in the last decade decreased in most of the countries in favour of total hysterectomy.
In some countries, the hysterectomy incidence rate has been reported to decline over time. This decrease is likely due to increased use of pharmacologic therapies and uterine-sparing procedures (ablative methods, hysteroscopic procedures) for gynaecologic conditions, especially abnormal bleeding disorders and leiomyomata.
However, given the increased mean age at hysterectomy over the last years, conservative treatment does not completely avert hysterectomy but, to some extent, postpones it until later ages.
Furthers explanations for such reduction in surgical volume of hysterectomies worldwide include the recent increase in the number of minimally invasive hysterectomies being performed as outpatient procedures.
Last but not least the use of enhanced recovery pathway decrease the mean lenght of stay, improve pain scores, and reduce hospital costs, without increasing perioperative complications. The use of such systematic implementation of evidence-based perioperative care protocol, support the more widespread use and application of outpatients procedures in the future.