Total abdominal hysterectomy

Approximately 600,000 hysterectomies are performed annually in the United States, and more than one-third of women have had a hysterectomy by age 60 years. The most common diagnoses among women undergoing hysterectomy are uterine leiomyomata (41%), endometriosis (18%), uterine prolapse (15%), and cancer or hyperplasia (12%). Other indications for hysterectomy include adenomyosis, pelvic infl ammatory disease, chronic pelvic pain, and pregnancy-related conditions. The uterus can be removed by a variety of different approaches including the abdominal route (laparotomy), transvaginally, or using minimally invasive surgical techniques. Selection of the operative approach is based on many factors including the physical properties and topography of the uterus and pelvis, the indication for surgery, patient body habitus and medical comorbidities, and the presence or absence of adnexal pathology. Abdominal hysterectomy allows the greatest ability to manipulate distorted pelvic anatomy or perform extensive adhesiolysis safely, and over 60% of hysterectomies performed in the United States are still performed via the abdominal approach. Although abdominal hysterectomy is typically associated with shorter operating times than minimally invasive surgical approaches, it is also associated with a higher level of incisional pain, greater risk of postoperative febrile morbidity and wound infection, longer hospital stay, and a more protracted recovery time. Hysterectomy may include removal of the uterine corpus and cervix, termed total hysterectomy, or may 2 C H A P T E R