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Although the vaginal route represents the most cost-effective surgical course for hysterectomy, choice of approach remains inconsistently determined. Investigators at the Mayo Clinic developed a decision-tree algorithm (based on uterine size, history of laparotomy, and vaginal access) to assist clinicians in selecting the most appropriate route. They then implemented the algorithm for women undergoing hysterectomy for benign indications. Decision-tree branches included a priori vaginal hysterectomy; examination under anesthesia in the operating room to determine whether to pursue vaginal, laparoscopic, or robotic hysterectomy; or a priori laparoscopic, robotic, or abdominal hysterectomy.
Of 365 women, 202 (55%) were expected to have a priori…