Laparoscopic versus vaginal hysterectomy for benign pathology

The following review is an attempt to clarify the current role of vaginal and laparoscopic approaches in case of hysterectomy for benign pathologies.

Recent researches establish that vaginal hysterectomy seems to be the gold standard in case of benign pathologies and should be performed in preference to abdominal hysterectomy wherever possible. When vaginal hysterectomy is not technically possible, laparoscopic hysterectomy is to be preferred to abdominal hysterectomy. No advantages of laparoscopic hysterectomy could be found over vaginal hysterectomy, in particular, because laparoscopic hysterectomy is associated with a higher rate of complications (especially bladder and ureteral injuries). Other authors, instead, show that laparoscopic hysterectomy permits a safe bilateral salpingo-oophorectomy (BSO), the treatment of additional pathologies at the time of surgery, a reduction of intraoperative bleeding, postoperative pelvic pain and length of stay compared with vaginal hysterectomy. Moreover, laparoscopic approach, in experienced hands, is not associated with any increase in major complication rate.

It's time to reduce abdominal hysterectomy in favour of mini-invasive approaches. To do so a suitable training and supervision are paramount before embarking on total laparoscopic hysterectomy (so that complications are minimized) or on vaginal hysterectomy (so to perform a planned BSO). It is also essential, particularly for total laparoscopic hysterectomy, to share the techniques used by different surgeons, the results and the complications concerning this approach.