McCarus Minimally Invasive Hysterectomy: 20 Years' Experience-Lessons Learned.

The advancement of surgical innovation for both devices and techniques has directly impacted the number of hysterectomy options available to patients. These advancements have led to an expansion of options that has been exceptionally impactful for minimally invasive surgery. For individuals who are diagnosed with a health condition or disease that requires a hysterectomy, these advances allow the surgeon to consider an expanded variety of procedures that may improve patients' outcomes and accommodate patient preferences. Automated suturing devices, improved energy systems, specialized mini-laparoscopic tissue handling instruments, and novel uterine manipulators, among other devices, all work together to provide hysterectomy options with cosmetically pleasing results from an aesthetic perspective. They also provide excellent medical outcomes from a surgeon's perspective. Patients are no longer subjected to large incisional scars from total abdominal hysterectomies that were commonly performed 25 years ago. All gynecological surgeons are obligated to provide patients with improved hysterectomy options that fit the indications and clinical needs of their patients. As the laparoscopic approach to a hysterectomy became the standard of care for many, variations in technique to successfully perform a laparoscopic hysterectomy has become a major limiting factor for generalists to incorporate this skillset into their practice. Maintaining the same procedural steps as the abdominal approach is one of the major hurdles that makes the transition to a laparoscopic approach more treacherous. Over 20 years of experience has shaped the McCarus hysterectomy technique described here into a safe and reproducible procedure that prioritizes the patient's aesthetic preferences while also providing optimal patient outcomes. The implementation of unique devices and instruments further expands the surgeon's technical skills and augments the procedure to make it an effective and preferable choice.