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In industrialized countries, the rates of hysterectomies as treatment for benign diseases of the uterus have fallen in the last twenty years due to the use of methods which preserve the uterus (IUDs with progestogen, endometrial ablation, myomectomy, etc.). In contrast, the study by Müller et al. reported an explosion in hysterectomy rates at one institution after laparoscopic methods (laparoscopic hysterectomy [LH] and laparoscopic supracervical hysterectomy [LSH]) were introduced, in 2004 to 2008. This huge increase can only be explained by a marketing effect (“new operation–new patients”) and more frequent indication of the procedure. The advantages of LH and LSH stated are low blood loss and short operating time, but these are not clinically significant.

Day-to-day clinical practice, confirmed by numerous studies, shows that vaginal hysterectomy by an experienced surgeon is the method requiring the shortest operating time, lowest consumption of resources, and highest patient satisfaction. However, laparoscopic methods have a powerful ally: the industry, which has an interest in promoting laparoscopic surgery, despite its high consumption of resources. Intensive marketing supported by the industry keeps the profile of laparoscopic hysterectomy methods constantly high by means of surgery courses on the subject for many and varied indications. Unlike LH and LSH, vaginal hysterectomy requires no specific instruments or newly available techniques, and thus offers few chances for marketing. This is very much to the detriment of women who need to have their wombs removed due to benign diseases, because vaginal hysterectomy leaves no scarring and removes the whole cervix, which might otherwise develop abnormalities that require repeat surgery. Vaginal hysterectomy should therefore remain the focus of professional training for gynecology surgeons, as it provides the most benefits for patients.

DOI: 10.3238/arztebl.2010.0796b

Prof. Dr. med. Johannes Dietl

Universitäts-Frauenklinik

Josef-Schneider-Str. 4

97080 Würzburg, Germany

Markert_F@klinik.uni-wuerzburg.de

or: frauenklinik@mail.uni-wuerzburg.de

1.
Müller A, Thiel FC, Renner SP, Winkler M, Häberle L, Beckmann MW: Hysterectomy—A comparison of approaches. Dtsch Arztebl Int 2010; 107(20): 353–9. VOLLTEXT
1.Müller A, Thiel FC, Renner SP, Winkler M, Häberle L, Beckmann MW: Hysterectomy—A comparison of approaches. Dtsch Arztebl Int 2010; 107(20): 353–9. VOLLTEXT

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