About 700,000 women undergo hysterectomy every year in the United States. The vast majority of these are performed for benign conditions, most commonly uterine fibroids. Unfortunately, at least 70% of these hysterectomies are still performed by laparotomy.

Numerous studies have demonstrated that 90-95% of these surgeries can be safely and successfully performed vaginally or by laparoscopic techniques. When laparotomy is avoided, postoperative pain is greatly reduced, the hospital stay is shortened by 1 to 3 days, recovery is shortened by 2 to 4 weeks, and the patient can return to normal activities much more rapidly.

Why are more women not offered these advantages? Unfortunately, many gynecologists are either not well trained in the techniques of vaginal and/or laparoscopic techniques or have very little experience with them. Most can perform laparotomy, so they recommend that method to their patients.

Myths concerning the route by which hysterectomy can or should be performed include:

If you have had a cesarean section, vaginal hysterectomy cannot be done. Numerous studies have shown this to be completely false. Skilled and experienced gynecologic surgeons do not consider 1, 2, or 3 prior cesarean sections to present a problem in performing vaginal or laparoscopically assisted vaginal hysterectomy.

You have never been pregnant or delivered a child vaginally, therefore you must be opened to perform your hysterectomy. Laparoscopically assisted vaginal hysterectomy (LAVH), Total laparoscopic hysterectomy (TLH), and Laparoscopically assisted supracervical hysterectomy (LASH) were developed with this situation in mind. All three avoid the problems associated with laparotomy.

Because you have fibroids, your hysterectomy must be performed by laparotomy. Using vaginal or laparoscopic "marcellation" techniques fibroids as large as a basketball can be removed without laparotomy. 10 to 12 centimeter fibroid uteri are routinely removed using thest techniques. Smaller ones are much simpler.

We can't see as well if we use a laparoscope or do the case vaginally. It is difficult to see the structures in the pelvis during vaginal hysterectomy. The laparoscope, however, offers 6 to 8 power magnification. We can, in fact, see the entire pelvis much better with a laparoscope than with the naked eye. Difficult surgery can be done more precisely because of this advantage.

Your hysterectomy simply cannot be done vaginally and the laparoscope is too risky. If the gynecologist is sufficiently skilled with vaginal and laparoscopic surgical techniques and has enough experience with these procedures, the need for laparotomy (for benign conditions) will be very rare. The most experienced gynecologic surgeons resort to laparotomy less than 5% of the time to complete hysterectomy for benign conditions.

Hysterectomy is your only alternative. Although hysterectomy may indeed be your best alternative for treatment of benign conditions, it is rarely your only option. If your gynecologist cannot or will not discuss other treatment alternatives, a second opinion might be a good idea.

Because my gynecologist says it can't be done, it can't be done. Unfortunately, this is often incorrect. For many reasons, gynecologists may not believe that any particular hysterectomy can be done by any other method than laparotomy. Simply ask if there is an alternative method. If your gynecologist is not familiar with vaginal or laparoscopic techniques to perform difficult hysterectomies, ask if he or she can refer you to someone who is.