Approach to selecting route of hysterectomy for benign disease

When performing hysterectomy for benign indications, the least invasive route that can be safely performed based on surgeon experience and available equipment is preferred.
We recognize that not all surgeons can offer both vaginal and laparoscopic hysterectomy as their minimally invasive approach.
Patients who elect vaginal or laparoscopic hysterectomy are counseled that, despite adequate preoperative planning, completion of hysterectomy by the intended route is not always possible and thus abdominal incision (ie, laparotomy) may be needed to complete the hysterectomy.

* Plan for performing risk-reducing salpingectomy and/or oophorectomy at the time of hysterectomy does not dictate the surgical route for hysterectomy.

¶ Patient characteristics such as nulliparity, obesity, and prior pelvic surgery are not absolute contraindications to vaginal surgery.

Δ Discussions of gynecologic malignancies and their treatments, including for borderline tumors, can be found in related content within UpToDate.

◊ Laparoscopic hysterectomy includes conventional laparoscopy and robot-assisted laparoscopy. The decision perform robot-assisted laparoscopic hysterectomy is usually based on surgeon preference and available resources.

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Approach to selecting route of hysterectomy for benign disease