The hysterectomy lottery

We report a postal survey of consultant gynaecologists carried out to determine the pattern of current hysterectomy practice, to obtain views on indications and contraindications to vaginal hysterectomy, and to predict future practice. There was a 75% response rate. Approximately two-thirds of hysterectomies were performed abdominally, one-third vaginally and 3% laparoscopically by each gynaecologist, although there was significant variation between them. The most common factors limiting the use of vaginal hysterectomy were a lack of uterine prolapse, the presence of fibroids and the need for prophylactic oophorectomy. It was predicted that there would be a significant change in hysterectomy practice with the majority being performed vaginally but still with a large variation. Gynaecologists who currently perform laparoscopic hysterectomy have the highest vaginal hysterectomy rates and predict the greatest role for it in the future. The large variations in practice indicate that the route of surgery is more dependent on the clinical preference of the gynaecologist than the medical condition.