Choice of route for hysterectomy – evaluation of procedures performed in the gynaecological department of the Tuchola District Hospital, from 2005 to 2008

Introduction: The latest trends in the field of hysterectomy have brought a marked reduction in the rate of open abdominal hysterectomy. The number of minimally invasive procedures – vaginal and laparoscopic hysterectomies – has increased in many settings.
Aim: This study evaluates the route of all hysterectomies performed in the gynaecology department of the District Hospital in Tuchola, from 01.01.2005 to 31.12.2008. It is a follow-up study of the initial report published by the same authors in 2007, in ‘Przegląd Menopauzalny’.
Material and methods: The authors analysed the percentage of hysterectomies performed via abdominal (AH), vaginal (VH) and laparoscopic access (LH) from 2005 to 2008, for benign diseases.
Results: A ten-fold decrease (from 81.35% in 2005 to 7.24% in 2007) in the rate of abdominal hysterectomy (AH) and three-fold increase in frequency of vaginal hysterectomy (VH), from 18.65% in 2005 to 60.71% in 2006, were observed. Use of laparoscopic hysterectomy (LH) increased from 36.24% in 2007 to 67.14% in 2008 – during 2 years from introduction of this procedure.
Conclusions:
1. A two-fold decrease in the first year, from 81.35 to 39.29%, and ten-fold decrease in the next year, to 7.24%, in the rate of abdominal hysterectomy (AH) was observed.
2. Systematic physician training and proper patient qualification are followed by an increase in use of vaginal hysterectomy (VH) up to 60%.
3. Conversion from laparoscopic hysterectomy to laparotomy and thermal injury to the ureter can occur in the beginning of the learning curve of LH.