Technique for total abdominal hysterectomy: historical and clinical perspective

Since the first refined total abdominal hysterectomy was performed by Wilhelm Alexander Freund of Breslau on January 30, 1878, various techniques have been introduced over the past 110 years. Hysterectomy, numbering over 650,000 procedures annually, is the most commonly performed major surgical procedure next to cesarean section in the United States. Although CREOG (Council on Resident Education in Obstetrics and Gynecology) emphasizes the importance of basic pelvic surgical skills and competency in gynecological surgical procedures, cost-effective patient management dictates the shortest hospitalization and most uncomplicated procedure possible. Various techniques of abdominal hysterectomy have been reappraised in view of present-day medical practice concepts. It seems that we are entering a new age wherein a simplified, cost-effective alternative to a classical total abdominal hysterectomy is indeed needed for some cases, and if a hysterectomy is planned, it should be performed in the safest way in the shortest possible operating time for a well-indicated case. Keeping this objective in mind, one Japanese technique of total abdominal hysterectomy and its modification are described with the intent that this will assist Ob/Gyn resident physicians in surgical skill development and also help gynecologists in practice to meet rapidly changing practice patterns of the specialty.