**7.1 Total or subtotal hysterectomy?**

Total abdominal hysterectomy is the procedure of choice, but subtotal PH may be a better choice in certain conditions where surgery needs to be completed in a shorter time. The advantages and disadvantages of subtotal PH are summarized in **Table 4** [1].


#### **Table 4.**

*Advantages and disadvantages of subtotal PH.*


#### **Table 5.**

*Causes of morbidity with PH.*

Both total and subtotal hysterectomy are associated with high morbidity and mortality [13]. Mean maternal mortality is reported to be about 4.8%. The causes of morbidity are listed in **Table 5** [17].

#### **7.2 Role of vessel sealing devices**

Based on the studies reviewed, vessel sealing devices have been shown to be effective and safe in achieving hemostasis during peripartum hysterectomies. They have been found to reduce operative time, blood loss, and the need for blood transfusions [23, 24]. Also, one of the studies claim they also reduce the number of intraoperative complications [23], while the other confines the benefit as not yet causing an increase [24]. The use of vessel sealing devices may be useful in both total and subtotal hysterectomies. However, it is important to note that vessel sealing devices should be used with caution and proper training to avoid complications such as thermal injury to adjacent tissues.
