2] a cochrane review from 2009 recommends vaginal hysterectomy over other variants where possible. Laparoscopic surgery offers certain advantages when vaginal surgery is not possible but has also the disadvantage of significantly longer time required for the surgery. [23] in direct comparison of abdominal (laparotomic) and laparoscopic techniques laparoscopic surgery causes longer operation time and substantially higher rate of major complications while offering much quicker healing. [23] [24] vaginal hysterectomy is the only available option that is feasible without total anaesthesia or in outpatient settings (although so far recommended only in rare cases). Time required for completion of surgery in the eval trial is reported as following: [24] abdominal 55. 2 minutes average, range 19-155 vaginal 46. 6 minutes average, range 14-168 laparoscopic (all variants) 82. 5 minutes average, range 10-325 (combined data from both trial arms) large multifibroid uteri and subtotal hysterectomies did previously require abdominal incision but with the use of in situ morcellation they can be sometimes also performed using laparoscopic or vaginal techniques. [25] even impacted fibroid uteri with severe adhesions, oblitered cul-de-sac and no motion whatsoever on pelvic exam can be removed laparoscopically by experienced laparoscopic surgeons. [26] the great majority of hysterectomies for benign indications can be performed by the vaginal technique with clear advantages. [17] [18] robotic surgery has very similar clinical outcomes like laparoscopic or vaginal techniques. Small advantages such less blood loss come at the cost of substantially longer operating times and higher costs. [27] [28] [29] robotic surgery does not benefit women with benign gynaecological disease [30] and concerns over widespread misleading marketing claims have been raised. [31] [edit] comparison of long term results and complication rates hysterectomy by abdominal laparotomy is correlated with much higher incidence of intestinal adhesions than other techniques. [32] this section requires expansion. (july 2012) [edit] benefits hysterectomy is usually performed for serious conditions and is highly effective in curing those conditions. viagra without a doctor prescription cheap viagra online viagra online generic viagra rx viagra for sale viagra for sale without a prescription buy viagra can you buy viagra without prescriptions viagra without a doctor prescription generic viagra online The maine women health study of 1994 followed for 12 months time approximately 800 women with similar gynecological problems (pelvic pain, urinary incontinence due to uterine prolapse, severe endometriosis, excessive menstrual bleeding, large fibroids, painful intercourse), around half of whom had a hysterectomy and half of whom did not. The study found that a substantial number of those who had a hysterectomy had marked improvement. viagra youtube