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Hysterectomy is one of the most common non-obstetric procedures performed in the United States, with more than 430,000 of them performed in 2010.(1,2)
In 1999, 11 % of women between 35-45 years of age had a hysterectomy, with an estimated annual cost of $5 billion.(3)
Minimally invasive hysterectomy (MIH) includes vaginal, laparoscopic, and robotic routes. Costs differ by surgical approaches(4-6), with total abdominal hysterectomy being the costliest approach due to a higher risk of complications and longer duration of hospital stay.
The American College of Obstetricians and Gynecologists (ACOG) and the American Association of Gynecologic Laparoscopists (AAGL) recommended the use of either vaginal or laparoscopic routes for benign indications in 2009 and 2011.(7,8)
Patients undergoing minimally invasive hysterectomy (MIV) often have a more favorable experience compared to those undergoing a conventional abdominal procedure.
MIH has proven to be as effective as abdominal surgery for many pathologies, and benefits the patient and employer with:
Complications, especially those associated with abdominal surgical procedures, impact LOS, treatment costs, recovery time, and patient satisfaction. For example, it has been shown that hospital acquired infections adds $4,528 to the cost of stay and 2.52 days to the length of stay.(11) Shorter LOS reflects effectiveness of symptom management, patient mobilization, and fewer if any complications.
Individuals undergoing MIH are more likely to go back to work activities faster than those having an abdominal procedure for the same condition. It has been shown that the time to return to normal activities was 18 days shorter for laparoscopic hysterectomy and 3.15 days shorter for vaginal hysterectomy when compared to an abdominal procedure.(12)
From an employer point of view, increased disability duration means higher rate of sick leave, disability payments, or even replacement employees; therefore, shorter disability duration will result in decreased costs. In many cases, both vaginal and laparoscopic can be performed in an outpatient setting.(13,14)
AAGL, the professional society for laparoscopic gynecologic surgery, believes that “a number of clinical situations considered as contraindications to laparoscopic hysterectomy seem not to have merit when subjected to critical analysis”(8) including obesity and previous cesarean section.
A study by Chopin et al. showed that the safety and efficacy of laparoscopic hysterectomy are similar for obese and non-obese patients.(15) Other studies showed that previous cesarean section should not be considered as a contraindication to either a vaginal hysterectomy or laparoscopic hysterectomy.(16,17)
However, when a vaginal hysterectomy is not feasible due to a large uterus or adhesions, laparoscopic hysterectomy seems to be a safer alternative rather than abdominal hysterectomy.(18,19)
It has been shown that the direct cost of both vaginal hysterectomy and laparoscopic hysterectomy are less than those for abdominal hysterectomy.(20,21)
AAGL believes that “abdominal hysterectomy should be reserved for the minority of women for whom a laparoscopic or vaginal approach is not appropriate. These circumstances are not common, and may include the following situations:”(8)
AAGL recommends that “surgeons without the requisite training and skills required for the safe performance of vaginal hysterectomy or laparoscopic hysterectomy should enlist the aid of colleagues who do or should refer patients requiring hysterectomy to such individuals for their surgical care.”(8)