Hysterectomies and tubal ligation were the two main sterilization methods used. Using the robotic system, gynecologists can perform hysterectomies, myomectomies, and lymph node biopsies. Women are also given hysterectomies and tubal ligations at the discretion of the medical officers. The newly introduced midwives system now perform major surgeries including Cesareans and hysterectomies. In 2007, the United Nations reported coercive sterilizations and hysterectomies in Uzbekistan. Robotic assisted surgery is presently used in several countries for hysterectomies. For example, prisons often perform forced hysterectomies on imprisoned women. In 2006, 149,456 hysterectomies were performed. It is considered an insignificant artery that is dissected during hysterectomies. Hysterectomies have also been linked with higher rates of heart disease and weakened bones. Neary said this was the main reason he carried out so many hysterectomies. In Canada, the "number" of hysterectomies between 2008 and 2009 was almost 47,000. Along with this is a similar rise in the risk of emergency hysterectomies at delivery. The number of hysterectomies in Germany has been constant for many years. In 2007, the number of hysterectomies decreased to 138,164.