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00:36:35 | 98 enrolled
Video Talk
Which route for Hysterectomy ? Evidence Based Guidelines Speaker: Shirish S. Sheth
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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.