Route of Hysterectomy for Benign Disease: Abdominal Hysterectomy

The role of abdominal hysterectomy for benign disease has decreased with time, given the broad application of minimally invasive hysterectomy. Abdominal hysterectomy is indicated when minimally invasive surgery is not feasible due to patient-, disease-, or technical-factors, including uterine size, risk of malignancy, or extensive endometriosis and adhesive disease. Conversion from minimally invasive hysterectomy might also be required when unexpected adhesive disease or intraoperative complications are encountered. Attention to preoperative preparation; surgical planning; and intraoperative setup, exposure, and use of available surgical assistance optimize the success of planned or emergent conversion to abdominal hysterectomy. Finally, intraoperative and advanced pelvic surgical techniques, as well as consultation with colleagues across subspecialties, can be utilized to facilitate safe surgery in patients with complex pelvic diseases or inadvertent intraoperative injuries.