Abstract
The route of hysterectomy has been a subject of controversy since the introduction of laparoscopy in the 1990s. We carried out a retrospective study on all the hysterectomies performed for benign lesions in our department between 1992 and 1999. We recorded, for each surgical procedure, the demographic figures, the preoperative work-up, and the peroperative data and postoperative course. Laparotomy was indicated for large uterus (p > 3-month pregnancy), laparoscopy was used in case of associated adnexal pathology, and access was free in every other cases. Statistical analysis was carried out with statistical software (SPSS 6.1, SPSS-FRANCE, Paris, France). A total of 142 cases were included: 71 in the laparotomy group, 32 in the vaginal group, and 39 in the laparoscopy group. Demographic figures, medical history, and preoperative data were similar in each group, with an exception for the uterus size, which was larger in the laparotomy group. Laparoscopic hysterectomies lasted longer (p < 0.001), and adnexectomies were less frequently performed by the vaginal route (p < 0.001). Peroperative complications were similar in each group, but blood transfusion was significantly more frequent during laparotomy (p = 0.001). Postoperative hospital stay was significantly longer after laparotomy (p < 0.001). Laparotomy was the favored approach for hysterectomy in 1992-1993, whereas it was rarely performed in 1998-1999 (p < 0.05). The vaginal route is now the most common access. In our experience, the vaginal route is now the standard access for hysterectomy for benign lesions.
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