ACOG Committee Opinion No. 444: Choosing the Route of Hysterectomy for Benign Disease

TLDR

Hysterectomies can be performed vaginally, abdominally, laparoscopically, or robotically, with evidence that vaginal approaches generally yield better outcomes and fewer complications, though data on robot‑assisted procedures remain limited. The committee recommends that physicians select the hysterectomy route and method based on safety, cost‑effectiveness, and patient needs, while acknowledging that evidence for robot‑assisted hysterectomy is still limited. If a vaginal hysterectomy is infeasible, surgeons should choose between laparoscopic, robot‑assisted, or abdominal approaches, and the decision to perform a salpingo‑ophorectomy is independent of the hysterectomy route.

Abstract

Hysterectomies are performed vaginally, abdominally, or with laparoscopic or robotic assistance. When choosing the route and method of hysterectomy, the physicians should take into consideration how the procedure may be performed most safely and cost-effectively to fulfill the medical needs of the patient. Evidence demonstrates that, in general, vaginal hysterectomy is associated with better outcomes and fewer complications than laparoscopic or abdominal hysterectomy. When it is not feasible to perform a vaginal hysterectomy, the surgeon must choose between laparoscopic hysterectomy,robot-assisted hysterectomy, or abdominal hysterectomy. Experience with robot-assisted hysterectomy is limited at this time; more data are necessary to determine its role in the performance of hysterectomy. The decision to electively perform a salpingoophorectomy should not be influenced by the chosen route of hysterectomy and is not a contraindication to performing a vaginal hysterectomy.