Hysterektomie: interventionelle Alternativen

If hysterectomy is medically indicated or there is a patient wish for guaranteed freedom from suffering, nowadays in order to avoid an abdominal hysterectomy, the preferred approaches are vaginal hysterectomy as well as laparoscopically-assisted procedures, such as total laparoscopic hysterectomy (TLH), laparoscopically-assisted supracervical hysterectomy (LASH) and laparoscopically-assisted vaginal hysterectomy (LAVH). The type of procedure used depends on the diagnosis, the wishes of the patient and the technical competence. Hysterectomy is not indicated in some cases and can often be replaced by organ preserving procedures especially for myomas and bleeding disorders. Enucleation of myomas and new procedures of myoembolization and magnetic resonance imaging-guided focused sonography are of great importance. An atrophy of the cervical mucosa in bleeding disorders by endometrial ablation can lead to an improvement and reduction of symptoms after exclusion of a malignancy and where there is no desire to have children. Robot-assisted surgery is being used increasingly more for hysterectomy and myoma enucleation.