Citation Information :
Khoiwal K, Garg P. A Comparative Evaluation of Total Laparoscopic Hysterectomy and Laparoscopic Supracervical Hysterectomy for Benign Uterine Diseases. World J Lap Surg 2021; 14 (1):30-33.
Background: Laparoscopic supracervical hysterectomy (LSH) is a minimally invasive alternative to total laparoscopic hysterectomy (TLH), which is a common procedure in developed countries. The study aimed to evaluate the safety (risks vs benefits) of LSH in the Indian scenario when compared with TLH in terms of intraoperative and postoperative outcome measures. Furthermore, quality of life (bladder, bowel, and sexual functions) was also evaluated.
Materials and methods: A prospective randomized study among 30 patients with benign uterine pathology for hysterectomy was included in the study. Patients were divided randomly into LSH (n = 15) and TLH (n = 15) groups. Intraoperative outcome measures, such as operation time, blood loss, and visceral injuries were noted. Postoperative outcome measures included absolute change in hemoglobin (Hb), duration of hospital stay, pain, urinary complaints (retention, dysuria), and bladder, bowel and sexual functions for 6 months.
Results: Demographic data were comparable in both groups. The operating time and blood loss were more in LSH than TLH group, (p = 0.29 and 0.37). The absolute change in hemoglobin was more in LSH group than TLH group (p = 0.001). Postoperative pain was indifferent in both the groups on postoperative day 0 and day 7 but it was significantly less in LSH group on day 1 (p = 0.03). Duration of hospital stay was similar in both groups. No patient required readmission. Patients in TLH group took a lesser number of days to return to routine activity compared to LSH group. The postoperative bladder, bowel, and sexual functions were comparable. The incidence of post-LSH vaginal bleeding was 13.3%. No vault prolapse was noted at the end of 6 months follow-up.
Conclusion: Laparoscopic supracervical hysterectomy is safe and efficacious as TLH for benign uterine pathologies but has no extra benefits rather is associated with a persistent risk of developing cervical diseases and malignancy.
Desai S, Shuka A, Nambiar D, et al. Patterns of hysterectomy in India: a national and state-level analysis of the Fourth National Family Health Survey (2015–2016). BJOG 2019;126(S4):72–80. DOI: 10.1111/1471-0528.15858.
Nieboer TE, Johnson N, Lethaby A, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev 2009;3:CD003677. DOI: 10.1002/14651858.CD003677.pub4.
Lieng M, Qvigstad E, Istre O, et al. Long-term outcomes following laparoscopic supracervical hysterectomy. BJOG 2008;115(13):1605–1610. DOI: 10.1111/j.1471-0528.2008.01854.x.
Cooper K, Breeman S, Scott NW, et al. Laparoscopic supracervical hysterectomy versus endometrial ablation for women with heavy menstrual bleeding (HEALTH): a parallel-group, open-label, randomised controlled trial. Lancet 2019;394(10207):1425–1436. DOI: 10.1016/S0140-6736(19)31790-8.
Johnson N, Barlow D, Lethaby A, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev 2006;3:CD003677. DOI: 10.1002/14651858.CD003677.pub4.
Jenkins TR. Laparoscopic supracervical hysterectomy. Am J Obstet Gynecol 2004;191(6):1875–1884. DOI: 10.1016/j.ajog.2004.06.096.
Zupi E, Zullo F, Marconi D, et al. Hysteroscopic endometrial resection versus laparoscopic supracervical hysterectomy for menorrhagia: a prospective randomized trial. Am J Obstet Gynecol 2003;188(1):7–12. DOI: 10.1067/mob.2003.60.
Lethaby A, Mukhopadhyay A, Naik R. Total versus subtotal hysterectomy for benign gynaecological conditions. Cochrane Database Syst Rev 2012;4:CD004993. DOI: 10.1002/14651858.CD004993.pub3.
Cipullo L, Paoli SD, Fasolino L, et al. Laparoscopic supracervical hysterectomy compared to total hysterectomy. JSLS 2009;13(3):370–375.
Einarsson J, Suzuki Y, Vellinga TT. Intramyometrial injection of vasopressin in laparoscopic supracervical hysterectomy. J Minim Invasive Gynecol 2008;15(2):197–201. DOI: 10.1016/j.jmig.2007.12.002.
Boosz A, Lermann J, Mehlhorn G, et al. Comparison of re-operation rates and complication rates after total laparoscopic hysterectomy (TLH) and laparoscopy-assisted supracervical hysterectomy (LASH). Eur J Obstet Gynecol Reprod Biol 2011;158(2):269–273. DOI: 10.1016/j.ejogrb.2011.04.021.
El-Mowafi D, Madkour W, Lall C, et al. Laparoscopic supracervical hysterectomy versus laparoscopic-assisted vaginal hysterectomy. J Am Assoc Gynecol Laparosc 2004;11(2):175–180. DOI: 10.1016/s1074-3804(05)60194-6.
Mueller A, Renner SP, Haeberle L, et al. Comparison of total laparoscopic hysterectomy and laparoscopy-assisted supracervical hysterectomy in women with uterine leiomyoma. Eur J Obstet Gynecol Reprod Biol 2009;144(1):76–79. DOI: 10.1016/j.ejogrb.2009.02.004.
Ozgur H, Elena T, Sertac E, et al. A comparison of short-term outcomes between laparoscopic supracervical and total hysterectomy. Am J Obstet Gynecol 2009;201(5):536.e1–536.e7. DOI: 10.1016/j.ajog.2009.07.048.
Kafy S, Al-Sannan B, Kabli N, et al. Patient satisfaction after laparoscopic total or supracervical hysterectomy. Gynecol Obstet Invest 2009;67(3):169–172. DOI: 10.1159/000184679.
Einarsson JI, Suzuki Y, Vellinga TT, et al. Prospective evaluation of quality of life in total versus supracervical laparoscopic hysterectomy. J Minim Invasive Gynecol 2011;18(5):617–621. DOI: 10.1016/j.jmig.2011.06.003.
Berlit S, Tuschy B, Wuhrer A, et al. Sexual functioning after total versus subtotal laparoscopic hysterectomy. Arch Gynecol Obstet 2018;298(2):337–344. DOI: 10.1007/s00404-018-4812-7.
Ghomi A, Hantes J, Lotze EC. Incidence of cyclical bleeding after laparoscopic supracervical hysterectomy. J Minim Invasive Gynecol 2005;12(3):201–205. DOI: 10.1016/j.jmig.2005.03.008.
Hellstrom AC, Sigurjonson T, Pettersson F. Carcinoma of the cervical stump. The radiumhemmet series 1959–1987. Treatment and prognosis. Acta Obstet Gynecol Scand 2001;80(2):152–157.