Explanation:
Hysterectomy is one of the most popular surgeries in the United States. The route of hysterectomy for benign disorders depends on the size of the uterus and vagina, accessibility, the need for concurrent procedures, surgical experience and comfort level, and patient preference. Minimally invasive techniques include vaginal, laparoscopic, and robotic-assisted laparoscopic methods.
The vaginal hysterectomy has become less popular over the years, likely secondary to the growth of laparoscopic and robotic technologies. In 1998, 25% of cases were done vaginally, whereas only 17% were strictly vaginal in 2010. Nevertheless, the vaginal hysterectomy results in better outcomes, shorter hospital stay and postoperative recovery, and is the most cost-effective method to remove the benign uterus.
Hysteroscopy with a tissue removal system (A) works well for fibroid types 0 to 3, not type 4 (intramural) fibroids. Open abdominal hysterectomy (B) has increased surgical morbidity, higher risk of hemorrhage and infection, and longer hospital stays, especially in patients with comorbidities. Uterine artery embolization (C) is best for intramural fibroids in premenopausal women. However, about 28% of patients subsequently undergo hysterectomy within 5 years due to symptom recurrence.
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