Comment on the New DGGG AWMF S3-Guideline on Hysterectomy, or a Plea for LAVH as the Gold Standard for Total Hysterectomy Procedures

I would like to start by congratulating Professors Klaus Neis (Saarbrücken) and Matthias Beckmann (Erlangen) for their work in coordinating the contributions to the Hysterectomy guideline. The AWMF S3-guideline was formulated in consensus with the German, Austrian and Swiss Societies for Gynecology and Obstetrics (DGGG, ÖGGG, SGGG). The guideline discusses the indications and methods used for hysterectomy based on an extensive search of the literature (1990–2012). The search included reviewing more than 450 citations, of which just under 300 were taken into account [1].

• References

• 1 Neis K, Kreienberg R, Beckmann MW et al. S3-Leitlinie zur Indikation und Methodik der Hysterektomie. AWMF online. Online: http://www.awmf.org/uploads/tx_szleitlinien/015-070e_S3_Indikation_und_Methodik_der_Hysterektomie_2015-07.pdf last access: 21.12.2015
• 2 Raatz D. Preoperative laparoscopy for determination of the surgical approach. Geburtsh Frauenheilk 1985; 45: 898-900
• 3 Reich H. Laparoscopic hysterectomy. Surg Laparosc Endosc 1992; 2: 85-88
• 4 Müller A, Thiel FC, Renner SP et al. Hysterectomy – a comparison of approaches. Dtsch Arztebl Int 2010; 107: 353-359
• 5 Cipullo L, Cassese S, Fasolino L et al. Laparoscopic hysterectomy and urological lesions: risk analysis based on current literature and preventive strategies. Minerva Ginecol 2008; 60: 331-337
• 6 De Wilde RL, Trew G. Postoperative abdominal adhesions and their prevention in gynaecological surgery. Gynecol Surg 2007; 4: 161-168
• 7 De Wilde RL, Trew G. Postoperative abdominal adhesions and their prevention in gynaecological surgery. Part 2. Gynecol Surg 2007; 4: 243-253
• 8 Yi YX, Zhang W, Zhou Q et al. Laparoscopic-assisted vaginal hysterectomy vs. abdominal hysterectomy for benign disease: a meta-analysis of randomized controlled trials. Eur J Obstet Gynecol Reprod Biol 2011; 159: 1-18
• 9 Schmidt EH, De Wilde RL. Standardverfahren der minimal-invasiven Chirurgie in der Frauenheilkunde. Stuttgart: Thieme; 1998: 137-145
• 10 Brandner P, Neis KJ. The significance of laparoscopically-assisted vaginal hysterectomy – LAVH. Zentralbl Gynakol 1995; 117: 620-624
• 11 Bojahr B, De Wilde RL, Tchartchian G. Malignancy rate of 10,731 uteri morcellated during laparoscopic supracervical hysterectomy (LASH). Arch Gynecol Obstet 2015; DOI: 10.1007/s00404-015-3696-z.
• 12 Tanos V, Brölmann H, De Wilde RL et al. Myoma morcellation and sarcoma panic. Gyn Surg 2015; 12: 17-19
• 13 Brölmann H, Tanos V, Grimbizis G et al. Options on fibroid morcellation. Gyn Surg 2015; 12: 3-15
• 14 Nezhat C. Morcellation during uterine tissue extraction. Online: http://www.aagl.org/wpcontent/uploads/2014/05/Tissue_Extraction_TFR.pdf last access: 21.12.2015
• 15 Tchartchian G, Dietzel J, Bojahr B et al. No more abdominal hysterectomy for myomata using a new minimally-invasive technique. Int J Surg Case Rep 2010; 1: 7-8
• 16 Mohan HM, OʼRiordan JM, Winter DC. Natural-orifice translumenal endoscopic surgery (NOTES): minimally invasive evolution or revolution?. Surg Laparosc Endosc Percutan Tech 2013; 23: 244-250
• 17 De Wilde RL, Herrmann A. Robotic surgery – advance or gimmick?. Best Pract Res Clin Obstet Gynaecol 2013; 27: 457-469