AAGL: Laparoscopic or Vaginal Hysterectomy Preferred

Obesity not considered contraindication to laparoscopic approach

FRIDAY, Nov. 12 (HealthDay News) -- Most hysterectomies for benign disease should be performed either vaginally or laparoscopically, according to a position statement by the AAGL (formerly known as the American Association of Gynecologic Laparoscopists and now referred to only by its acronym) published online Nov. 9 in the Journal of Minimally Invasive Gynecology.

According to the position paper, approximately 600,000 hysterectomies were performed in the United States annually through 2005, with more than two-thirds performed abdominally despite the existence of vaginal and laparoscopic approaches, which are less invasive and associated with lower morbidity in most cases.

The AAGL recommends that vaginal (VH) or laparoscopic hysterectomies (LH) should be considered for most women needing a hysterectomy, unless specific contraindications or clinical situations exist. For LH, these situations include the presence of cardiopulmonary disease, where the risks of increased intraperitoneal pressure with LH could outweigh the benefit, and either known or suspected uterine malignancy. Obesity should not be considered a contraindication to LH, according to the paper.

"Given the advantages that VH and LH offer to women, their families, their employers, and the health care system in general, it seems desirable to optimize their application in women requiring hysterectomy because of benign uterine conditions. Abdominal hysterectomy should be reserved for the minority of women for whom a laparoscopic or vaginal approach is not appropriate," the report states.

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