route of hysterectomy

Question 1

factors to consider in choosing route of hyst

Answer 1

• uterine size/pathology, shape
• adnexal pathology
• prior pelvic surgery
• adhesive disease
• prior CD (although can still perform)
• parity (nulliparity should not limit)

Question 2

TAH vs TVH

Answer 2

• TVH decreased EBL
• TVH decreased hospital stay
• TVH quicker return to normal activities
• no difference in complications, satisfaction, intraoperative injury
• no evaluation in difference of cost

Question 3

TVH vs TLH

Answer 3

• TVH shorter length of surgery
• Lower overall cost
• No difference in complication rate (from low powered studies; per ACOG CO)

Question 4

TLH vs TAH

Answer 4

• TLH faster recovery
• TLH higher ureteral injury rate
• TLH longer OR time
• TLH higher QOL at 4 years
• No difference in satisfaction, long term complications

Question 5

TLH vs robot

Answer 5

• no difference in outcomes

- no cost studies

Question 6

reasons to select for robotic case?

Answer 6

benefits 3D vision, articulated instruments (theoretically better manipulation, thermal energy device application)

• complex procedures
• lack of experienced assistant
• for trainee purposes
• operating with partner/other surgeon where they have selected surgical approach