[Hysterectomies for benign pathology: is there a place for laparoscopic surgery?].

Study objective: To investigate the alternative routes for hysterectomy for benign disease and the appropriate role of laparoscopic surgery.

Design: Retrospective study of hysterectomies performed between August 1991 and July 1997.

Setting: University hospital.

Patients: Hysterectomy for benign disease without prolapse, pelvic floor relaxation.

Intervention: 359 hysterectomies: vaginal (n = 211), laparoscopically-assisted vaginal (n = 56), and abdominal (n = 92).

Measurements and main results: Uterine volume was the principal indication for laparotomy. Laparoscopy was required only in cases of adnexal disorders or when the vaginal access was limited or associated with extensive adhesions. The rate of laparotomies and laparoscopies dropped steadily over the six-year study period: during the last two years, 75% of all hysterectomies were vaginal, and 90% of those for patients without a previous vaginal birth.

Conclusion: With experienced surgeons, the number of cases in which there appears to be poor vaginal accessibility experience decreases, and indications for vaginal hysterectomies increase.