Vaginal Hysterectomy: The Original Minimally Invasive Approach

2016 Annual Clinical Meeting

Michael Moen, MD, FACOG

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Vaginal Hysterectomy: The Original Minimally Invasive Approach

Vaginal hysterectomy is one of the most familiar of all gynecologic surgeries. The earliest written reference dates back to 50 BC, and the first recorded vaginal hysterectomy was performed in 120 AD.

Despite overwhelming evidence favoring vaginal hysterectomy, however, it has lost ground to laparoscopic and robotic approaches in recent years. In 1990, about 75 percent of hysterectomies performed in the U.S. used the abdominal approach and 25 percent used the vaginal approach.

The rise of laparoscopic and robotic procedures is largely a result of changes in training and marketing. Gynecologic residency and fellowship training programs have focused on minimally invasive procedures for two decades. And while vaginal hysterectomy is the least invasive of all approaches, it often seen as conventional and old school because it uses conventional surgical instruments and techniques that are unfamiliar to surgeons trained in laparoscopic and robotic approaches.

"There is nothing marketable about a procedure over 100 years old that uses standard instruments," he said. "We have solid scientific evidence to support vaginal hysterectomy, but it is not being used as often as it should be. We need to level the playing field by increasing the awareness of the vaginal approach."

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