Hysterectomy for benign gynaecological disease

Of all the treatments available for the management of abnormal uterine bleeding, hysterectomy scores highest in satisfaction rates. It should therefore not surprise that despite the advent of newer, and in some instances less invasive, interventions hysterectomy remains the most commonly performed major gynaecological operation. It is therefore imperative that all aspects of this operation are reviewed on a regular basis, as there are aspects that raise concern. For example, all evidence suggests that the vaginal route is the safest, most cost-effective approach to hysterectomy, affording rapid recovery, yet the majority of hysterectomies are still performed by the abdominal route. Newer approaches such as robotic surgery have captured the imagination of the enthusiasts, yet this approach is hugely expensive, and there are few data justifying its use over the laparoscopic or indeed the conventional approach. Quality of life should remain the principal outcome measure for hysterectomy for benign disease, and therefore the impact of the various approaches to hysterectomy should address this outcome, but often fail to do so. Complications of any new technique should be addressed, and the question that continues to elude an answer, namely why there are such widely and wildly varying rates of hysterectomy between surgeons in one hospital, between hospitals in one region, between the regions and between countries, should be the subject of rigorous and definitive research.