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LAPAROSCOPIC HYSTERECTOMY, WHAT IS THE LIMIT?

Author : Hermanus Suhartono

Abstract

Hysterectomy is one of the most frequently performed surgical procedures in the United States. During 2000–2004, approximately 3.1 million hysterectomies were performed (approximately 600,000 per year). The most common indications for hysterectomy are symptomatic uterine leiomyomas (40.7%), endometriosis (17.7%), and prolapse (14.5%)1 . Hysterectomies are performed vaginally, abdominally, or with laparoscopic or robotic assistance. When choosing the route and method of hysterectomy, the physician should take into consideration how the procedure may be performed most safely and cost-effectively to fulfill the medical needs of the patient. Most literature supports the opinion that, when feasible, vaginal hysterectomy is the safest and most cost-effective route by which to remove the uterus.2 However, analysis of U.S. surgical data shows that abdominal hysterectomy is performed in 66% of cases, vaginal hysterectomy in 22% of cases, and laparoscopic hysterectomy in 12% of cases.3 Factors That Influence the Route of Hysterectomy Factors that may influence the route of hysterectomy for benign causes include the size and shape of the vagina and uterus; accessibility to the uterus; extent of extrauterine disease; the need for concurrent procedures; surgeon training and experience; available hospital technology, devices, and support; emergency or scheduled cases; and preference of the informed patient.4 Key words: Laparoscopic, Laparotomy Hysterectomy.

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