Evidence is gathered out of study and collation of several factors. Cochrane Data and evidence based studies as well as the ACOG have opined that the vaginal route for hysterectomy is the best choice of route and only when this is not possible, laparoscopic surgery should be resorted to, to spare the abdomen from being opened.
In the present study, important situations which are not contraindications but are often used as an excuse for not performing vaginal hysterectomy, are discussed at length. Some of these are nulliparity, a large uterus or a uterus with fibroids (even though it is less than 12 weeks in size), a history of C. Section(s), need to remove the ovaries and possibly flimsy adnexal pathology. The place of subtotal hysterectomy is crystallized in the presentation. Often emphasised, but not heeded to, surgical invasion is the least with vaginal hysterectomy amongst all the available methods, followed by the laparoscopic and abdominal methods. The decision of resorting to the laparoscope is clearly enunciated. As it stands, scientific evidence rejects robotic hysterectomy and/or emphasizes further studies to evaluate its usefulness.
Thus, the evidence based algorithm is to proceed from a vaginal to a laparoscopic and then to the abdominal route.
Shirish Sheth completed his specialty training at Wadia Maternity Hospital & J.J. Groups of Hospital, Mumbai, India. He has had a distinguished career as a gynaecologic surgeon, and was the Hon. Professor of Obstetrics and Gynaecology at King Edward Memorial Hospital and Seth G.S. Medical College until 1994. He still works as a Consultant Gynaecologist at Breach Candy Hospital and Sir Hurkisondas Hospital in Mumbai.
Professor Sheth has served as President, College of Physicians and Surgeons of Bombay (1984-85); President, Federation of Obstetrics and Gynaecological Societies of India (1990-91); and was President, International Federation of Gynaecology and Obstetrics (FIGO) from 2000-03. Prof. Sheth has published 148 scientific papers, and has contributed numerous chapters to Obstetrical and Gynaecological textbooks. He also co-authored medical monographs on Menorrhagia (with Prof. Christopher Sutton) in 1999 and on Vaginal Hysterectomy (with Prof. JWW Studd) in 2002. He has travelled widely to lecture and demonstrate vaginal surgery for operative workshops. Prof. Sheth was Conferred FRCOG (ad eundem) in 1996. He has been honoured with many awards including the Lion Heart Award for outstanding contributions in the field of vaginal surgery by the One Kilo Club, International College of Surgeons, USA.