Laparoscopic Supracervical Hysterectomy
Laparoscopic Supracervical Hysterectomy - LSH
There are approximately 600,000 hysterectomies performed each year in the United States. Hysterectomy is the 2nd most common major operation in the United States (Cesarean is #1). Approximately 1 in 3 women have undergone hysterectomy by the age of 60.
This outpatient procedure involves laparoscopic removal of the uterine body, and the patient is able to keep her cervix. The patient can either keep her ovaries or have them removed at the same time. Fallopian tubes are often removed since it is now believed that fallopian tubes are the source for epithelial cancers of the ovaries. Pelvic supports are left intact. Since there is no vaginal incision, there is less contamination by vaginal bacteria. This outpatient approach is associated with less pain, fewer adhesions, and a quicker recovery than the open approach. This is a nice way to manage a large fibroid uterus without having to do a big incision. Other conditions, such as endometriosis and adhesions, can be treated at the same time. Pelvic support procedures can be preformed at the same time. This outpatient approach is associated with less pain, fewer adhesions, and a quicker recovery than the open approach.
Total Hysterectomy vs. Partial, Subtotal, Supracervial Hysterectomy
Total Hysterectomy (“hyster” means uterus, “ectomy” means to remove) is removal of the uterine body and cervix. Partial, Subtotal, Supracervical Hysterectomy is removal of the uterine body and the patient keeps the cervix. “Total” hysterectomy makes no statement regarding the ovaries and fallopian tubes. Removal of ovaries and fallopian tubes is separate. Ovaries and fallopian tubes can be removed or conserved with total or partial hysterectomy.
Indications For Hysterectomy
Pain, Bleeding, Uterine Fibroids, Pelvic Prolapse, Malignancy, Pelvic Inflammatory Disease, some cases of Adenomyosis, and some cases of Endometriosis. Many years ago, before we had modern Anesthesia, Blood Banks, and Antibiotics, all hysterectomies were partial. There was mortality with simple procedures, and the goal was to complete the surgery as rapidly as possible. Since modern Anesthesia, Blood Banks, and Antibiotics, for decades all hysterectomies were total. Today, both Total and Partial/Supracervical Hysterectomy are done safely with excellent results.
Advantages of Supracervical Hysterectomy
Patients felt it might be better for sexual function. In regards to intercourse after hysterectomy, it is more related to why the procedure was done. If a significant medical problem was resolved, sexual activity will likely be improved. Advantages of Supracervical Hysterectomy:
a) Protecting pelvic supports. Supporting tissues between bladder and vagina, between rectum and vagina, and uterosacral and cardinal ligaments at the bottom of the pelvis, all insert into the cervix. With Supracervical hysterectomy these attachments remain intact. Pelvic Prolapse can occur even when there has been No prior pelvic surgery. Therefore, Supracervical Hysterectomy does Not prevent prolapse, it just does not do anything to bring Prolapse on.
b) Lower infection rate. The cervical canal is a smaller communication between the vagina and abdominal cavity, as compared to the open vaginal apex in total hysterectomy, with less contamination of the abdominal cavity.
c) Less risk of trauma to the bladder. Total removal of cervix requires more mobilization of bladder.
Disadvantages of Supracervical Hysterectomy
Pain and bleeding from the cervix. If the endocervical canal is not removed, then significant bleeding may persist. If the surgeon removes most of the endocervical canal, leaving supportive tissues on the outer portion of the cervix, then cervical bleeding will be minimal or none. All patients who choose Supracervical Hysterectomy need to accept: There can pain, bleeding, infection, adhesions, dysplasia of the cervix requiring medical/surgical treatment and/or removal of the cervix later on. Morcellation (removing the uterus in pieces) is not an option due to concern of spread of a uterine malignancy. Therefore, Supracervical Hysterectomy requires enlargement of one of the abdominal incisions to remove specimen. Surgical choice is based on specific patient concerns, taking into account what is important to the patient.
Controversies Regarding the Supracervical Hysterectomy
***THERE IS CURRENTLY A CONTROVERSY WITH LAPAROSCOPIC MORCELLATION. THE PROCESS OF MORCELLATION COULD SPREAD AND UPSTAGE A UTERINE FIBROID MALIGNANCY.
THEREFORE, MORCELLATION OF UTERINE FIBROID TUMORS AND MORCELLATION OF THE UTERUS IS CURRENTLY NOT AN OPTION, AND A LAPAROTOMY INCISION IS REQUIRED TO REMOVE THE SPECIMEN.
Supracervical Hysterectomy Surgical Photos
Frequently Asked Questions About Laparoscopic Supracervical Hysterectomy
What is the uterus made up of?
The uterus is a thick muscular organ that consists of 3 parts: cervix, uterine body, and uterine fundus. The fundus is the upper portion of the uterus above where the fallopian tubes attach. The uterine body is the major portion of the uterus between the uterine fundus and cervix. The cervix is the lower part of the uterus that communicates with the vaginal canal. Hysterectomy (“hyster” means uterus, “ectomy” means to remove) is removal of the uterus.
How are total, partial, and supracervical hysterectomies different?
Removal of the entire uterus, including the cervix, is called total hysterectomy. Removal of the upper uterus (uterine body and fundus), conserving the cervix, is called partial hysterectomy. Since partial hysterectomy is above a portion of the cervix, this is also known as supracervical hysterectomy. These procedures can be done by laparotomy (open) or by laparoscopy (endoscopic).
How safe and common are hysterectomies?
Many years ago, before blood banks, antibiotics, and modern anesthesia, surgery was dangerous with high mortality. Surgical procedures were kept as short as possible, and all hysterectomies were partial hysterectomies. With the advent of blood banks, modern anesthesia, and antibiotics, total hysterectomies were performed. Total hysterectomy and supracervical hysterectomy are both good procedures being preformed today.
What is morcellation?
Morcellation is a procedure where a specimen, such as uterine fibroids, is removed in smaller pieces, allowing the surgeon to avoid making a large abdominal incision and perform these surgeries on an outpatient basis. Uterine fibroids have a small risk, an approximately 0.5% chance, of malignancy. If a uterine malignancy was morcellated, this could possibly spread the tumor and upstage the malignancy. Therefore, Dr. Robbins no longer performs morcellations. Uterine fibroids and the fibroid uterus are managed with laparoscopy, and then the specimens are removed from the abdomen through a small laparotomy incision. This practice allows for minimal discomfort from the laparotomy incision.
Do you have a question about laparoscopic supracervical hysterectomies?
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