Supracervical Hysterectomy

Quality of life and sexual function in patients aged 35 years or younger undergoing hysterectomy for benign gynecologic conditions: A prospective cohort study

OBJECTIVE

To evaluate how hysterectomy performed for benign gynecologic pathologies affects the quality of life and sexual function of patients aged 35 years or younger, and if outcomes differ according to the surgical technique.

METHODS

Seventy-three patients who underwent total laparoscopic hysterectomy (TLH), supracervical laparoscopic hysterectomy (SLH), or vaginal hysterectomy (VH) for benign uterine disorders between April 2014 and June 2020 at the Department of Gynecology and Obstetrics, Saarland University Hospital, Homburg, Germany, were enrolled in this prospective observational cohort study. Quality of life and sexual function were assessed preoperatively and 6 months postoperatively using standardized validated questionnaires: the European Quality of Life Five-Dimension Scale (EQ-5D) and the Female Sexual Function Index (FSFI).

RESULTS

Thirty-three (45%) patients underwent TLH, 25 (34%) underwent SLH, and 15 (21%) patients underwent VH. The median preoperative EQ-5D score, FSFI score, and EQ-5D visual analog scale were 0.9 (range 0.62-1), 19.25 (range 2.4-27.4), and 50 (range 0-100); postoperative scores were 1 (range 0.61-1), 24.15 (range 3.9-29.3), and 90 (range 30-100), respectively (P ≤ 0.001). Postoperative scores were significantly higher than preoperative scores, with no significant difference according to the surgical technique.

CONCLUSION

Hysterectomy for benign indication in women aged 35 years or less significantly improved the patients' quality of life and sexual function with no differences regarding the surgical technique.

CLINICAL TRIAL REGISTRATION

The study was registered in the German trial registry (no. DRKS00005622).

Effect of hysterectomy due to benign diseases on female sexual function: A systematic review and meta-analysis

OBJECTIVE

Determination of the effect of hysterectomy due to benign diseases on female sexual function DATA SOURCES: A search was performed on Scopus, PubMed, Science Direct, ProQuest, ISI Web of Knowledge and Embase databases. The keywords included Hysterectomy (as exposure) and Female sexual function (as outcome). Original English observational studies, including cohort, case-control, and cross-sectional studies published as of February 2021, which reported an association between any type of hysterectomy due to benign female disease and sexual function as an outcome, were included in the study. Studies in participants who received HRT and had sex other than heterosexuals were not included. There was no limit to the initial search period, and articles published by February 2021 were searched.

METHODS OF STUDY SELECTION

The search process resulted in the retrieval of 5,587 potentially related articles. After removing duplicated studies, the title and abstract were reviewed and 77 articles remained with the removal of unrelated items. The full text of 14 articles was published in non-English languages, and 52 articles were removed because they did not meet the inclusion criteria, and finally 11 articles were included in the final analysis.

TABULATION, INTEGRATION, AND RESULTS

The Newcastle-Ottawa Scale was used to assess the methodological quality of included studies. The evidence was synthesized using meta-analysis via random effect model with the Der Simonian and Laird weighted method. Publication bias was assessed using the funnel plot and Begg's and Egger's tests. The pooled standardized mean difference for sexual function in hysterectomy versus non-hysterectomy group was .08 (CI95%: -.38 to .55; I² = 96.8%; χ² = 307.94, p-value <.001; τ² = .59). Publication bias and small study effects were not detected. The results of the subgroup analysis showed that the possible sources of heterogeneity are the World Bank countries' classification and type of hysterectomy (in some studies the type of hysterectomy was not specified separately for the study groups, because of this, comparisons were made between Total and supracervical/total). Pooled SMD was affected by type of sexual function scale, World Bank countries' classification, type of hysterectomy, ovary status, and reproductive status. The results of meta-regression analysis also showed that for each month of distance from hysterectomy, women's sexual function score increases by .18.

CONCLUSION

The results of the present study showed that hysterectomy due to benign disease does not change the sexual function significantly.

REGISTRATION OF SYSTEMATIC REVIEWS

The study protocol was registered in PROSPERO system with the code CRD42021228314.

Colpotomizer-assisted Total Abdominal Hysterectomy (CATAH Technique): A New Technique for Uterine Removal in Benign Pathologies

OBJECTIVES

The aim of this study is to evaluate the applicability and feasibility of Colpotomizer-assisted total abdominal hysterectomy (CATAH), a new technique for uterine removal in benign uterine pathologies.

MATERIALS AND METHODS

This study is a prospective cohort study conducted at a tertiary University hospital in Egypt. Eligible patients (n = 88) for total abdominal hysterectomy (TAH) were divided into two groups; the study group who underwent TAH by the CATAH technique and the control group who underwent TAH by the conventional technique. Demographic data, operative time, blood loss, and operative complications were recorded.

RESULTS

The mean operative time was significantly reduced (64.47 ± 3.60 min) in the study group than in the control group (86.42 ± 5.54 min, P < 0.001). The mean time for cervical removal was significantly less (8.60 ± 1.39 min) in the study group than (17.77 ± 2.62 min) in the control group (P < 0.001). The mean volume of blood loss was less (197.38 ± 39.42 ml) in the study group than in the control group (462.69 ± 167.96 ml). Complications were fewer in the study group than in the control group.

CONCLUSION

The CATAH technique was feasible, quicker with less intraoperative and postoperative complications than the conventional technique for TAH in benign uterine pathologies.

Effect of Surgical Trainee Presence on Vaginal Hysterectomy Outcomes

STUDY OBJECTIVE

Because of the rapid decline in vaginal hysterectomy (VH) cases in recent years, there is concern regarding gynecologic surgical training and proficiency for VH. The objective of this study is to determine the effect of surgical trainee involvement on surgical outcomes in VH cases performed for benign indications.

DESIGN

Retrospective, multicenter, cohort study (Canadian Task Force classification II-2).

SETTING

Participating hospitals in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) at various international sites.

PATIENTS

Women who underwent VH for benign indication enrolled from the ACS-NSQIP from 2006 to 2012.

INTERVENTION

ACS-NSQIP database.

MEASUREMENTS AND MAIN RESULTS

Our study included 5756 patients who underwent VH, and surgical trainees were present in 2276 cases (39.5%). Patients who had a trainee present during VH were more likely to be older, nonsmoking, have comorbidities, and be classified as American Society of Anesthesiologists class III or IV. They were also more likely to be admitted as inpatients, undergo concomitant adnexal surgery, and have uterine weight greater than 250 g. Trainee presence during VH was associated with increased rates of overall complications (5.1% vs 3.19%, p < .001), urinary tract infection (5.27% vs 2.64%, p < .001), and operative time (124.25 ± 59.29 minutes vs 88.64 ± 50.9 minutes, p < .001). After controlling for baseline characteristics, trainee presence was associated with increased odds of overall complications (adjusted odds ratio, 1.63; 95% confidence interval, 1.25-2.13), urinary tract infection (adjusted odds ratio, 2.02; 95% confidence interval, 1.51-2.69), and prolonged operative time (adjusted odds ratio, 3.65; 95% confidence interval, 3.20-4.15). No differences were observed for other measures of surgical morbidity or mortality.

CONCLUSION

Despite the increased patient complexity and operative time associated with teaching cases, the involvement of surgical trainees is associated with urinary tract infection but not with any major surgical morbidity or mortality. These findings have important implications for gynecologic surgical training for VH.

Intraoperative cervical treatment does not affect the prevalence of vaginal bleeding 1 year postoperatively after subtotal hysterectomy. A register study from the Swedish National Register for Gynecological Surgery

INTRODUCTION

The objectives were to establish the prevalence of persistent vaginal bleeding following subtotal hysterectomy, to analyze the effect of intraoperative cervical treatment on the occurrence of persistent vaginal bleeding, and to evaluate the impact of persistent vaginal bleeding on the patient-reported opinion concerning result of surgery and medical condition.

MATERIAL AND METHODS

Retrospective study with data from the Swedish National Register for Gynecological Surgery including 5240 women undergoing subtotal hysterectomy for benign conditions between January 2004 and June 2016. Demographic and clinical data were obtained from the pre- and perioperative forms. Data concerning occurrence of persistent vaginal bleeding, rating of medical condition and contentment with result of surgery were collected from the 1-year inquiry form. Statistical analyses were performed with multivariable logistic regression models. The results are presented as adjusted odd ratios and 95% confidence intervals.

RESULTS

Persistent vaginal bleeding occurred in 18.6%. Intraoperative cervical treatment did not affect the frequency of persistent vaginal bleeding (adjusted odds ratio 1.48; 95% confidence interval 0.93-2.37). More than 90% were satisfied with the result of the hysterectomy, but women with persistent vaginal bleeding were less content compared with those without persistent vaginal bleeding (adjusted odds ratio 0.42; 95% confidence interval 0.26-0.67). The self-perception of the medical condition did not differ between the women with and without persistent vaginal bleeding (adjusted odds ratio 1.16; 95% confidence interval 0.33-4.12).

CONCLUSIONS

Nearly two in ten women may expect persistent vaginal bleeding following subtotal hysterectomy, and cervical treatment intraoperatively did not affect this. More than 90% were satisfied with the result but women with persistent vaginal bleeding were less content. Preoperative information on this risk of persistent vaginal bleeding may be important when choosing hysterectomy technique.

Prognosis of women with apparent stage I endometrial cancer who had supracervical hysterectomy

OBJECTIVE

To examine characteristics and survival outcomes of women with apparent early-stage endometrial cancer who had a supracervical hysterectomy.

METHODS

The Surveillance, Epidemiology, and End Results Program was used to identify women with presumed stage I endometrial cancer who underwent supracervical hysterectomy between 1983 and 2012. Propensity score matching was performed to adjust background difference between supracervical hysterectomy (n=1,339) and total hysterectomy (n=110,523) cases. Endometrial cancer-specific survival (CSS) was examined by multivariable analysis expressed with adjusted-hazard ratio [HR] and 95% confidence interval [CI].

RESULTS

Supracervical hysterectomy was independently associated with younger age, low-grade disease, and small tumor size on multivariable analysis (all, P<0.001). After propensity score matching, supracervical hysterectomy remained an independent prognostic factor for decreased CSS compared to total hysterectomy (10-year rates, 91.0% versus 94.9%, adjusted-HR 1.72, 95%CI 1.20-2.47, P=0.003). Among women who received postoperative radiotherapy, 10-year CSS rates were similar between supracervical and total hysterectomy cases (84.7% versus 80.3%, P=0.40). Contrary, in the absence of postoperative radiotherapy, women undergoing supracervical hysterectomy had a significantly lower 10-year CSS rate compared to those undergoing total hysterectomy (92.1% versus 97.2%, P<0.001). Moreover, with lack of lymphadenectomy, supracervical hysterectomy was associated with decreased CSS compared to those who had total hysterectomy (91.6% versus 94.3%, P=0.018) but had similar CSS rates with lymphadenectomy (92.7% versus 91.8%, P=0.91).

CONCLUSION

Although rarely performed, supracervical hysterectomy is associated with decreased survival outcome among women with apparent stage I endometrial cancer supporting the importance of avoiding this procedure in women with or at risk of endometrial cancer.

Indications and Route of Hysterectomy for Benign Diseases. Guideline of the DGGG, OEGGG and SGGG (S3 Level, AWMF Registry No. 015/070, April 2015)

Background: Official guideline "indications and methods of hysterectomy" to assign indications for the different methods published and coordinated by the German Society of Gynecology and Obstetrics (DGGG), the Austrian Society of Gynecology and Obstetrics (OEGGG) and the Swiss Society of Gynecology and Obstetrics (SGGG). Besides vaginal and abdominal hysterectomy, three additional techniques have been implemented due to the introduction of laparoscopy. Organ-sparing alternatives were also integrated. Methods: The guideline group consisted of 26 experts from Germany, Austria and Switzerland. Recommendations were developed using a structured consensus process and independent moderation. A systematic literature search and quality appraisal of benefits and harms of the therapeutic alternatives for symptomatic fibroids, dysfunctional bleeding and adenomyosis was done through MEDLINE up to 6/2014 focusing on systematic reviews and meta-analysis. Results: All types of hysterectomy led in studies to high rates of patient satisfaction. If possible, vaginal instead of abdominal hysterectomy should preferably be done. If a vaginal hysterectomy is not feasible, the possibility of a laparoscopic hysterectomy should be considered. An abdominal hysterectomy should only be done with a special indication. Organ-sparing interventions also led to high patient satisfaction rates, but contain the risk of symptom recurrence. Conclusion: As an aim, patients should be enabled to choose that therapeutic intervention for their benign disease of the uterus that convenes best to them and their personal life situation.

A Simple Approach to Specimen Retrieval via Posterior Colpotomy Incision

Introduction:

Posterior colpotomy incision for specimen retrieval is infrequently used in gynecologic laparoscopic surgery unless a concomitant hysterectomy is performed. We aim to describe a simple and unique technique for creating the colpotomy incision and to describe intraoperative and postoperative outcomes.

Methods:

Fifty patients underwent adnexal specimen retrieval through a posterior colpotomy incision. After devascularization and detachment of the adnexal specimen, the posterior cul-de-sac was visualized. The colpotomy incision was created by introducing a 12- or 15-mm laparoscopic trocar through the vagina into the posterior vaginal fornix under direct visualization. Specimens were placed into laparoscopic bags and removed through the vagina. The colpotomy incision was closed vaginally. Charts were reviewed for intraoperative and postoperative outcomes.

Results:

Twenty-nine women underwent adnexal surgery for an adnexal mass, 14 women underwent surgery for pelvic pain, and 7 women underwent adnexal surgery for primary prevention of malignancy. The specimens removed ranged in size from 2 to 16 cm (mean 5.7). The mean time patients were under anesthesia was 103 minutes (SD 57.3). There were no operative complications related to the colpotomy incision and no cases of postoperative vaginal cellulitis or pelvic infection were reported. Only 1 woman with a prior vaginal delivery reported dyspareunia postoperatively.

Conclusion:

This simple technique for posterior colpotomy incision can easily be added to the gynecologic surgeon's armamentarium and can be safely used for most women.

Critical analysis of cases of endometrial carcinoma of the uterine corpus incidentally diagnosed after incomplete surgery for other indications. Three case reports and a review of the literature

Incidental diagnosis of endometrial carcinoma after the operation for presumed benign disease is rare. At present, there are no recognized guidelines on optimal management of uterine malignancy diagnosed after incomplete surgery for other indications and the reported experience is limited. Although the risk of histological diagnosis of endometrial carcinoma in the uterus removed for pre-operatively diagnosed benign disease is very low, one should always bear in mind that it may indeed occur. Omission of certain diagnostic procedures prior to hysterectomy may result in incidental finding of a malignancy at or after surgery, even when preoperative imaging studies reveal benign disease. Many centres develop their own strategies, although in most cases the adnexa and cervix are removed and thorough exploration of the abdominal cavity is performed. Also, in view of the technical difficulties involved in removing the uterus and adnexa via the vagina and a potential high risk of cancer either developing in the cervical stump or disseminated from inadvertently morcellated uterine fragments, one should carefully consider the potential benefits and risks of supracervical hysterectomy. We present three patients with endometrial carcinoma diagnosed after hysterectomy, who subsequently underwent completion surgery. A review of the literature follows, which presents opinions from international centres.

Trends in laparoscopic surgery for hysterectomy in Korea between 2007 and 2009

AIMS

The aims of this study are to estimate the hysterectomy rate for benign disease and determine recent trends in laparoscopic surgery for hysterectomies, including subtotal, total, and radical hysterectomy, in Korea.

MATERIAL AND METHODS

Computerized discharge summaries from private and public hospitals for 2007-2009 were obtained from the Health Insurance Review & Assessment Service. All records listing subtotal and total hysterectomies for benign disease and radical hysterectomies in women aged ≥ 16 years in each period were selected (n = 99,388). All women living in Korea aged ≥ 16 years were the denominator population. Laparoscopic surgery was identified when the code for laparoscopic materials was used. Statistical analysis included a trend test.

RESULTS

The hysterectomy rates for benign disease were 1.48, 1.49, and 1.52/1000 women aged ≥ 16 years in 2007, 2008, and 2009, respectively, and the overall rate was 1.49/1000 women. The trend increased (P for trend <0.001). The use of laparoscopy for subtotal and total hysterectomies accounted for 43.1% in 2007, 47.7% in 2008, and 52.0% in 2009, which showed a clear increasing trend (P for trend <0.001). The use of laparoscopy for radical hysterectomies comprised 26.7%, 28.7%, and 38.2% of cases in 2007, 2008, and 2009, respectively, an increased trend (P for trend <0.001).

CONCLUSION

The hysterectomy rate for benign disease increased between 2007 and 2009 in Korea. Application of laparoscopy during subtotal, total, and radical hysterectomies has increased significantly.

Assessment tool for total laparoscopic hysterectomy: a Delphi consensus survey among international experts

OBJECTIVE

 To achieve consensus among experts on the essentials steps to include in an assessment tool for total laparoscopic hysterectomy. 

METHODS

 Using a Delphi consensus process, an initial survey was created based on the current literature and local expertise in laparoscopic surgery and sent to international experts in laparoscopic gynaecology. Experts were selected according to specific criteria. A second survey was formulated based on the answers and comments from the first round and sent to all experts who participated in the first round. Consensus was defined as a Cronbach alpha ≥ 0.80. A rate of agreement ≥ 0.70 was used to define which substeps to keep in the final tool.

RESULTS

 From the 85 experts invited to participate, 53 (62%) agreed to participate, and 51 of these participated in both rounds. The final instrument to assess total laparoscopic hysterectomy was created using the items with a high level of agreement after two rounds. This final tool showed good internal consistency among the experts, with a Cronbach alpha of 0.90.

CONCLUSION

 Using a Delphi methodology, we achieved international consensus among experts in laparoscopic gynaecology within a short time frame and with minimal costs. The resulting evaluation tool for total laparoscopic hysterectomy may serve in the assessment of surgical skills in the future, and would be a valuable adjunct to postgraduate training and continuing medical education programs. This tool will now undergo a validation process, comparing the rating scores of novices and experts surgeons.

Effects of Hysterectomy on Sexual Function

Hysterectomy remains the most common major gynecological surgery. Postoperative sexual function is a concern for many women and their partners. In this respect, a beneficial effect of hysterectomy for benign disease independent of surgical techniques or removal of the cervix has been demonstrated in the past decade by the majority of studies. For about 20 % of women, deteriorated sexual function has been reported and current research is attempting to identify mechanisms and predictive factors explaining these postoperative changes. Alternative treatments of benign uterine disorders or uterus preserving surgery for genital prolapse appeared to have similar outcomes in terms of sexual function. Concomitant oophorectomy had negative effects on sexual function and long-term health, particularly in premenopausal women. This may not be reversed by estrogen replacement. Hysterectomy performed for malignancy had a detrimental effect on sexual function. Individualized risk assessment and information should be aimed at during preoperative decision making.

Vaginal trachelectomy following laparoscopic supracervical hysterectomy and sacrocervicopexy

BACKGROUND

Current evidence supports cervical preservation at the time of abdominal prolapse repair using synthetic mesh to minimize vaginal mesh extrusion. This report aims to describe management of benign cervical disease following laparoscopic sacrocervicopexy including successful trachelectomy performed vaginally.

CASE

A 70-year-old sexually active woman presented with symptomatic pelvic organ prolapse and stress urinary incontinence. Her Papanicolaou smears over several years were unremarkable, and she had a benign endocervical polyp removed in the office 3 months before surgery. She underwent an uncomplicated robotic-assisted laparoscopic supracervical hysterectomy and sacrocervicopexy. She presented 8 months after surgery with persistent vaginal spotting after intercourse and was found to have a recurrent endocervical polyp. Ultimately, she underwent uncomplicated trachelectomy performed vaginally with resolution of her symptoms.

CONCLUSIONS

Retention of the cervix at the time of mesh-augmented abdominal prolapse repairs introduces a unique set of evaluation and management considerations for benign cervical disease. Trachelectomy performed vaginally was successful and uncomplicated in this case.

Prospective cohort study and meta-analysis of cyclic bleeding after laparoscopic supracervical hysterectomy

OBJECTIVE

To evaluate a modified technique of laparoscopic supracervical hysterectomy (LSH) on rates of postoperative cyclic bleeding (PCB).

METHODS

A retrospective study was conducted of 173 women who underwent LSH with bipolar electrocoagulation of the endocervical canal at Landeskrankenhaus Wolfsberg, Wolfsberg, Austria, between January 1, 2005, and December 31, 2009. Long-term follow-up was assessed using a questionnaire. A systematic literature review and a meta-analysis of 13 studies that reported on PCB after LSH were also conducted.

RESULTS

In all, 164 women (94.8%) had uneventful intraoperative and postoperative courses. By contrast, 9 of 146 premenopausal women (6.2%) experienced PCB. The meta-analysis (n=1822) revealed an overall PCB rate of 7.1%. Bipolar electrocoagulation of the endocervical canal was the most effective method for prevention of PCB (bleeding rate, 2.9%) followed by unipolar electrocoagulation (bleeding rate, 9.9%). Uterine resection below the internal cervical orifice was more effective for preventing PCB (13 of 633 women; 2.1%) than either amputation at this site or above this site (27 of 537 women [5.0%] and 88 of 640 women [13.8%]).

CONCLUSION

Bipolar coagulation of the endocervical canal and extensive resection with amputation below the level of the internal cervical orifice were effective for reducing rates of PCB.

Unexpected malignancies after laparoscopic-assisted supracervical hysterectomies (LASH): an analysis of 1,584 LASH cases

OBJECTIVE

The objective of this research was to identify the rate of unexpected malignancies after laparoscopic-assisted supracervical hysterectomies (LASH) and describe the therapy regime.

METHODS

The research is based on a retrospective chart analysis of patients undergoing a simple hysterectomy in the gynecological endoscopy department of a general hospital in Germany.

RESULTS

2,577 simple hysterectomies conducted between March 2005 and March 2010 were sub-classified in different types of hysterectomies (vaginal-, abdominal-, total-, abdominal supracervical hysterectomy, LAVH, and LASH). This study focuses on the LASH sub-group of 1,584 patients and does not make any comparisons to other operative approaches. Out of the 1,584 patients, 87.8 % (n = 1,391) received preoperative screening to exclude dysplasia or malignancy based on the policy of the German Association for gynecology and obstetrics (DGGG). The screening includes cytology (Pap-smear) and preoperative ultrasound of the uterus or dilatation and curettage (d&c). Unexpected malignancies were found in 0.25 % (n = 4) of the patients pre-screened according to DGGG protocol. Out of the four malign patients, two had endometrial cancer. Two patients had leiomyosarcoma.

CONCLUSION

The study shows that there is a small probability of unexpected malignancies even in correctly pre-screened patients for LASH procedures. Yet in the short-term (28-52 months), malign patients remain recurrence free after treatment. LASH is therefore a good procedure for assumed benign disease.

Massive delayed vaginal hemorrhage after laparoscopic supracervical hysterectomy

Background. A known complication of supracervical hysterectomy is cyclical bleeding from the retained cervix when functioning endometrial tissue is not totally removed. We present a rare case of delayed postoperative vaginal hemorrhage after supracervical hysterectomy. Case. A 44-year-old woman presented on postoperative day 15 after laparoscopic supracervical hysterectomy with massive vaginal hemorrhage requiring emergent re-operation. Her bleeding was controlled with vaginally placed sutures. Ultrasound confirmed no intraperitoneal free fluid. The etiology was thought to be induced by postoperative tissue necrosis from cautery applied to the endocervical canal during the original surgery. Conclusion. Delayed vaginal hemorrhage from a retained cervix is a rare complication of laparoscopic supracervical hysterectomy. Caution should be exercised when cauterizing the endocervical canal as induced tissue necrosis may increase the risk of postoperative bleeding.

Mesh erosion following abdominal sacral colpopexy in the absence and presence of the cervical stump

INTRODUCTION AND HYPOTHESIS

We compared the role of abdominal sacral colpopexy (ASCP) with concomitant supracervical hysterectomy to ASCP alone in patients with prior hysterectomy in the prevention of mesh erosion.

MATERIALS AND METHODS

We performed a retrospective chart review of 277 consecutive patients who underwent ASCP with one surgeon. Patients were separated into two groups based on the presence of a uterus at the time of surgery. Group A comprised195 patients with a uterus who underwent ASCP and concomitant supracervical hysterectomy; group B comprised 82 patients with prior total hysterectomy who underwent ASCP. The outcome measures included peri- and postoperative findings, complications, and surgical success. Data were analyzed by t test and chi-square test using SPSS software.

RESULTS

No significant difference was found between groups during surgery in terms of anesthesia type, total operative time, and estimated intraoperative blood loss. At mean postoperative follow-up of 7-8 months, there was no difference between groups in terms of de novo urinary symptoms, recurrent vaginal-wall prolapse, or dyspareunia and Pelvic Organ Prolapse Quantification (POP-Q) point C examination. Sling erosion was observed in four (4.2 %) patients in group A versus none in group B. Apical mesh erosion was diagnosed in one patient in group A (0.5 %) and two (2.4 %) patients in group B. These differences were not statistically significant.

CONCLUSION

Concomitant supracervical hysterectomy with ASCP was associated with a low incidence of mesh erosion and had the same intraoperative course and postoperative outcome as ASCP with previous hysterectomy.

Comparative analysis of different laparoscopic hysterectomy procedures

PURPOSE

To compare the antecedent gynecological characteristics, indications for, and complications associated with, the different laparoscopic approaches to hysterectomy, in women with benign gynecological conditions.

METHODS

A retrospective cohort study of 957 patients who underwent laparoscopic supracervical (LSH), total (TLH), and assisted vaginal (LAVH) hysterectomies between January 2003 and December 2009.

RESULTS

Among 957 LH, 799 (83.5%) were LSH, 62 (6.4%) TLH, and 96 (10.1%) LAVH. Demographic characteristics were not different among the groups. Antecedent gynecologic conditions that were associated with the type of laparoscopic hysterectomy (LH) performed were: postmenopausal bleeding [LAVH vs. LSH, odds ratio (OR) 2.20; 95% confidence interval (CI) 1.04-4.65], previous pelvic surgery (TLH vs. LSH, OR 1.92; CI 1.05-3.52), previous cesarean delivery (LAVH vs. LSH, OR 0.39; CI 0.21-0.76), and prior hysteroscopy (LAVH vs. LSH, OR 0.29; CI 0.16-0.50). Preoperative diagnoses that were associated with the choice of LH were: menometrorrhagia (LAVH vs. LSH, OR 0.23; CI 0.14-0.38; TLH vs. LSH, OR 0.50; CI 0.26-0.98), uterine fibroids (LAVH vs. LSH, OR 0.25; CI 0.15-0.41), endometrial hyperplasia (TLH vs. LSH, OR 5.5; CI 2.04-14.84), and cervical dysplasia (TLH vs. LSH, OR 17.1; CI 6.83-42.79; LAVH vs. LSH, OR 8.05; CI 3.05-22.06). Estimated blood loss, operating time, and length of hospital stay were significantly reduced with LSH.

CONCLUSION

Antecedent gynecological history and the indications for surgery were associated with the type of LH performed in our institution. LSH was the most common approach and was associated with significantly less morbidity.