Abdominal Hysterectomy

Abdominal hysterectomy was first performed in 1843. Prior attempts at removal of the uterus date back to ancient times, when vaginal hysterectomy was performed to treat uterine prolapse or inversion. Laparoscopic assistance was used to facilitate minimally invasive hysterectomy in 1989 and further advanced in 2005 with the approval of the robotic-assisted technique. Today, abdominal, vaginal, laparoscopic, robot-assisted, and a combination of vaginal and laparoscopic techniques are utilized for hysterectomy. The surgical approach to hysterectomy depends on the clinical indication, the technical experience of the surgeon, the resources available, the general health condition of the patient, and patient preference. An abdominal hysterectomy involves the removal of the uterus through an incision in the abdominal wall. As minimally invasive techniques have become more available, the rates of abdominal hysterectomy have declined since the less invasive approaches offer benefits such as less post-operative pain, expedited recovery times, and better short-term quality of life after surgery, as well as shorter hospitalization stays and reduced costs. Furthermore, the use of hysterectomy, in general, has decreased as alternatives to hysterectomy continue to gain favor, such as endometrial ablation for symptomatic uterine bleeding and uterine artery embolization for uterine leiomyomas. Still, hysterectomy remains the most appropriate management option for many patients. Large uterine size has been cited as a common reason for choosing the abdominal approach to hysterectomy, as it has been thought that an enlarged uterus may require better visualization and exposure due to higher risks of blood loss, injury to neighboring viscera, and prolonged operating times. However, there are no specific recommendations up to which uterine weight or size should qualify a patient for abdominal hysterectomy, and studies have shown that minimally invasive techniques, such as laparoscopy, can safely remove larger uteri. Despite these findings, abdominal hysterectomy remains a common route of surgery being most commonly indicated for uterine fibroids, followed by abnormal uterine bleeding, prolapse, and endometriosis.