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Hysterektomie – vaginal, abdominal oder laparoskopisch assistiert?

Hysterectomy – vaginal, abdominal or laparoscopy assisted?

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Der Gynäkologe Aims and scope

Zusammenfassung

Die Hysterektomie ist einer der häufigsten gynäkologischen Eingriffe. Die Gebärmutter kann abdominal, vaginal, laparoskopisch assistiert – per laparoskopisch assistierter vaginaler Hysterektomie (LAVH) –, suprazervikal laparoskopisch oder total laparoskopisch entfernt werden. Die am weitesten verbreitete Methode ist die abdominale Hysterektomie. Studien haben mehrfach gezeigt, dass die Patientin nach vaginalem Vorgehen am schnellsten wieder der täglichen Routine nachgehen kann. Ein Großteil bisheriger Kontraindikationen für ein vaginales Vorgehen wurde in aktuellen Untersuchungen widerlegt. Es konnte gezeigt werden, dass selbst sehr große Uteri ohne erhöhte Morbidität vaginal entfernt werden können. Die LAVH empfiehlt sich für Patientinnen mit Voroperationen im kleinen Becken, zusätzlichen intraabdominalen Pathologien oder geplanter Adnexektomie. Ein abdominales Vorgehen bietet normalerweise keine Vorteile und sollte, bei benignen Grunderkrankungen, nur noch wenigen Indikationen vorbehalten bleiben.

Abstract

Hysterectomy is one of the most common gynaecologic operations. Different methods of hysterectomy exist, including abdominal, vaginal, laparoscopy-assisted vaginal (LAVH), and total or supracervical laparoscopic operation. The most common way to perform a hysterectomy is still the abdominal approach, but many studies have proven that vaginal hysterectomy is a less invasive method with the fastest convalescence. Conditions frequently given as contraindications for vaginal hysterectomy have been disproven as such, and it has been shown that even large uteri can be removed vaginally. LAVH is recommended for patients with previous pelvic surgery or additional abdominal problems or for patients with indications for adnectomy. Abdominal hysterectomy usually has no advantages and should be performed for special indications only.

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  1. Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland

    A. Hornemann, M. Thill, M.K. Bohlmann, D. Fischer, K. Diedrich & C. Altgassen

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  1. A. Hornemann
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  2. M. Thill
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  3. M.K. Bohlmann
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  4. D. Fischer
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  5. K. Diedrich
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  6. C. Altgassen
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Correspondence to A. Hornemann.

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Hornemann, A., Thill, M., Bohlmann, M. et al. Hysterektomie – vaginal, abdominal oder laparoskopisch assistiert?. Gynäkologe 41, 337–342 (2008). https://doi.org/10.1007/s00129-008-2129-5

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