Route of Hysterectomy: Vaginal

Vaginal hysterectomy is considered the preferred approach for benign hysterectomy due to its cost-effectiveness, safety, and low morbidity. Efforts to increase vaginal hysterectomy utilization, including endorsement by the American College of Obstetricians and Gynecologists and the American Association of Gynecologic Laparoscopists, has had limited impact on national trends. Marketing from companies and shifts in practice patterns along with lack of resident education have exacerbated the problem. Deeply engrained, though unfounded, perceived contraindications to a vaginal approach (e.g., prior surgery, nulliparity, uterine size, and risk factors for extrauterine disease) limits consideration of this approach further. This review presents evidence against these commonly perceived contraindications and provides a peer-reviewed algorithm that can be implemented to increase vaginal hysterectomy utilization safely. As minimally invasive technologies continue to evolve, surgeons have the responsibility to seek candidates that would benefit from the original-and most minimally invasive-approach to benign hysterectomy.