Factors influencing the choice of hysterectomy approach for the management of fibroid uterus

AimThe aim of this study was to identify factors influencing the choice between different approaches in hysterectomy for uterine fibroids.MethodsA cross-sectional study was conducted involving 285 women who had undergone hysterectomy for uterine fibroids at the Liverpool Hospital, New South Wales, Australia.ResultsThis study shows that several factors influenced the choice of hysterectomy approach. First, concomitant adnexal surgery increased the likelihood of undergoing an abdominal hysterectomy rather than either a vaginal or a laparoscopic hysterectomy by 10- and fivefold (both p < 0.01), respectively. Second, women with a larger uterus (>280 g) had a 20 (p < 0.05) and 10 (p < 0.01) times greater chance of undergoing an abdominal hysterectomy than either a vaginal or a laparoscopic hysterectomy, respectively. Third, gynecologic endoscopists were more likely to perform laparoscopic hysterectomy than gynecologic generalists (p < 0.001).ConclusionCertain clinical parameters determine the choice of hysterectomy approach. Surgeons' expertise also has significant influence over the choice between laparoscopic and traditional approaches for hysterectomy.