Abstract
Hysterectomy for benign gynecological conditions is a common operation that has developed
extensively through the last 20 years. Methods and surgical techniques vary throughout
the regions in Denmark as well as internationally. Consequently, the Danish Health
Authority initiated a national clinical guideline on the subject based on a systematic
review of the literature. A guideline panel of seven gynecologists formulated the
clinical questions for the guideline. A search specialist performed the comprehensive
literature search. The guideline panel reviewed the literature and rated the quality
of evidence according to the Grading of Recommendations Assessment, Development and
Evaluation (GRADE). Finally, the panel weighted the evidence and formulated the clinical
recommendations. Based on the limited available literature and the corresponding quality
of evidence according to GRADE, the guideline panel gave the following recommendations:
↓ Subtotal hysterectomy should only be preferred over total hysterectomy after careful
consideration because there are documented disadvantages such as persistent cyclic
vaginal bleeding (⊕ΟΟΟ). ↑ Consider vaginal hysterectomy rather than conventional laparoscopic hysterectomy
for non-prolapsed uteri when feasible (⊕ΟΟΟ). ↓ Robot-assisted laparoscopic hysterectomy
should only be preferred over conventional laparoscopic hysterectomy after careful
consideration because the beneficial effect is uncertain and because of the longer
operating time (⊕⊕ΟΟ). ↑ Consider concomitant bilateral salpingectomy at the time of hysterectomy if the procedure
is not considered to increase the risk of complications significantly (⊕ΟΟΟ). ↑ Consider vaginal vault suspension to the cardinal and the uterosacral ligaments when
performing hysterectomy for non-prolapsed uteri (⊕ΟΟΟ). Though supporting evidence
is missing, the guideline panel emphasizes that it is good practice not to morcellate
uteri with presumed fibroids inside the peritoneal cavity (√). The recommendations serve as professional advice in specific clinical situations.
The implementation of the guideline in Denmark will be monitored through the national
Danish Hysterectomy and Hysteroscopy Database.
Keywords
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Article info
Publication history
Published online: July 20, 2017
Accepted:
July 8,
2017
Received in revised form:
June 24,
2017
Received:
February 21,
2017
Identification
Copyright
© 2017 Elsevier B.V. All rights reserved.
