Knowledge base

Removal of the uterus (womb) was mentioned as long ago as 5th century BC by Hippocrates, the father of medicine. However, apart from sporadic reports, hysterectomy was not practised until the 19th century. Even then, the mortality of the procedure was extremely high. It was only after improvements in antisepsis, anaesthesia and surgical technique to control haemorrhage in the mid-19th century that hysterectomy became an accepted procedure.

The early hysterectomies were usually done vaginally, but the introduction of subtotal hysterectomy late in the 19th century meant that abdominal hysterectomy became dominant; vaginal hysterectomy tended to be restricted for the management of uterine prolapse.

In 1988, the first laparoscopic hysterectomy was done by Harry Reich (USA). Although the procedure has failed to become popular, one result of this development was the wider appreciation of the role of vaginal hysterectomy. Studies showed that compared with the other routes, vaginal hysterectomy has the shortest operating time, fastest recovery and lowest cost.

Most gynaecologists now agree that vaginal hysterectomy is the optimal route and should be practised whenever possible.