Hysterectomy (surgical removal of the uterus) may be performed via an abdominal, vaginal, or laparoscopically-assisted vaginal approach. Once the decision has been made to proceed with hysterectomy, the physician must decide upon the route, which depends upon clinical circumstances and the surgeon's technical expertise. (See "Overview of hysterectomy".)
Issues related to vaginal hysterectomy will be reviewed here. Other hysterectomy procedures are discussed separately. (See "Abdominal hysterectomy" and "Laparoscopic approach to hysterectomy".)
INDICATIONS AND CONTRAINDICATIONS
The indications for and alternatives to hysterectomy are discussed elsewhere. (See "Overview of hysterectomy".)
Regarding contraindications, in general, gynecologic malignancies should not be approached by a vaginal approach, and prior pelvic radiation is also a relative contraindication.
The reason for the hysterectomy, risks and benefits of the procedure, alternatives, and expectations for outcome, should be discussed with the woman in detail. Few procedures for benign disease engender as much patient anxiety and concern as hysterectomy. There are a number of indications for hysterectomy that are based more upon opinion than evidence from well-designed studies. In these situations, informed consent with thorough exploration of patient preferences and expectations is most important.