In an open hysterectomy, do you incise through the serosal and myometrial layers to the endometrium and then remove the uterus with the endometrium intact?

From the Guidelines

In an open hysterectomy, surgeons should dissect around the entire uterus to remove it intact, without incising through the serosal and myometrial layers to the endometrium. This approach is crucial in preventing spillage of endometrial contents, which is particularly important in cases of suspected malignancy, as highlighted in the study on recent progress in endometrial cancer 1. The procedure typically begins with an abdominal incision through the skin, subcutaneous tissue, and fascia to access the peritoneal cavity. The surgeon then identifies the uterus and its supporting structures, including the broad ligaments, uterine vessels, and cardinal ligaments, and systematically clamps, cuts, and ligates them to free the uterus. Key considerations include:

• Separating the uterus from the bladder anteriorly and the rectum posteriorly
• Detaching it from the vagina or cervix (depending on whether it's a total or subtotal hysterectomy)
• Maintaining the integrity of the myometrium and endometrium within the uterus throughout the process As noted in the study, removing the uterus intact is a recommended practice, especially when minimally invasive surgery is used, to avoid morcellation and potential dissemination of malignant cells 1. By following this approach, surgeons can minimize the risk of injury to surrounding structures like the bladder, ureters, and bowel, and ensure the best possible outcomes for patients undergoing open hysterectomy.

From the Research

Surgical Procedure for Open Hysterectomy

• The provided studies do not directly describe the step-by-step procedure for an open hysterectomy, including whether the incision goes through the serosal and myometrial layers to the endometrium and then removes the uterus with the endometrium intact 2, 3, 4, 5, 6.
• These studies focus on the selection of the route of hysterectomy for benign disease, the advantages and disadvantages of different approaches, and the importance of discussing options with patients 2, 3.
• They also discuss the benefits of minimally invasive approaches, such as vaginal and laparoscopic procedures, over open abdominal hysterectomy 4, 5.
• However, they do not provide detailed information on the specific surgical techniques used in open hysterectomy.

Minimally Invasive Approaches

• Vaginal and laparoscopic procedures are considered minimally invasive surgical approaches because they do not require a large abdominal incision 2, 3, 4, 5.
• These approaches are typically associated with shortened hospitalization and postoperative recovery times compared with open abdominal hysterectomy 2, 3, 4, 5.
• The vaginal approach is preferred among the minimally invasive approaches, and laparoscopic hysterectomy is a preferable alternative to open abdominal hysterectomy for those patients in whom a vaginal hysterectomy is not indicated or feasible 2, 3, 4, 5.