INTRODUCTION

Hysterectomy is one of the most frequently performed of all surgical operations. Approximately 10,000 hysterectomies are performed annually in Finland and one fifth of women over 45 years of age have their uterus removed. The annual incidence of hysterectomy in Finland has been lower than in the United States, the same as in the United Kingdom but the highest among Nordic countries (Easterday et al. 1983; Luoto et al. 1994; Davies et al. 1998). However, the incidence has increased from 340/100,000 in 1987 to 414/100,000 in 1992 in Finland (Vuorma et al. 1998).

Traditionally the uterus has been removed by an abdominal or vaginal route. In spite of the lower complication rate in vaginal hysterectomies (Dicker et al. 1982), abdominal hysterectomy has been the main method of hysterectomy in the United States, the United Kingdom and Finland (Easterday et al. 1983; Luoto et al. 1994; Davies et al. 1998). Ten years ago 92% of hysterectomies were performed abdominally in Finland (Luoto et al. 1994). The optimum approach to hysterectomy would retain the advantages of the abdominal route, which include clear visualization and ease of manipulation of the adnexal stuctures, and to combine these features with the principal advantage of vaginal hysterectomy, namely avoidance of a large abdominal incision. Laparoscopic hysterectomy tries to combine these techniques and it has already influenced approaches to hysterectomy, offering a short recovery for the patient (Garry 1998).

This study evaluates the advantages and disadvantages of laparoscopic hysterectomy and its influence on other methods of hysterectomy in Finland.