Colposcopic, cytological and histological evaluation of the cervical stump 3 years after supravaginal uterine amputation

Evaluation of complications, conversion rate, malignancy rate, and, surgeon's experience in laparoscopic assisted supracervical hysterectomy (LASH) of 1274 large uteri: A retrospective study

INTRODUCTION

Hysterectomy now belongs to standard gynecological procedures. Moreover, a shift towards laparoscopic techniques is ever more apparent as they provide many advantages such as less traumatization and shorter convalescence. Large uteri are still mentioned as contraindications for laparoscopic hysterectomy even though those patients might benefit from the lower morbidity associated with minimal invasive techniques. In this study, the largest reported so far, we analyzed intraoperative and postoperative complications as well as the surgeon's experience of laparoscopic assisted supracervical hysterectomy (LASH) in patients with a uterus weight over 500 g.

MATERIAL AND METHODS

The present retrospective study, between June 27, 1998 and August 31, 2019, evaluates 1274 patients with a uterus weight over 500 g who were treated with LASH for benign uterine diseases at the Clinic for Minimal Invasive Surgery (Berlin, Germany). All surgeries were performed by one of four in-house surgeons with experience in LASH: they had performed at least 500 LASH procedures before the study. Patients receiving surgical treatment for malignant tumors were not included in the study. Major and minor intraoperative and postoperative complications were recorded and evaluated. Additionally, medical files were evaluated for demographic data, American Society of Anesthesiologists score (I-IV), name of the surgeon, duration and indication for surgery, history of previous gynecological procedures and concomitant surgical interventions, weight of removed uterine tissue, duration of postoperative hospitalization in patients with complications, intraoperative conversion from laparoscopy to laparotomy, and malignancy rate.

RESULTS

The mean age was 47.0 ± 7.3 years and mean body mass index was 25.6 ± 7.1 kg/m² . Average parity was 1.04 ± 1.57. Average uterus weight was 761.8 ± 317.9 g (500-4065 g). The mean duration of surgery was 96.9 ± 49.5 min; 54% of all patients were treated without concomitant intervention, conversion rate was 2.12%. The malignancy rate was 0.4% and the complication rate was 6.81% with 1.36% intraoperative complications and 5.45% postoperative complications.

CONCLUSIONS

The overall low complication and malignancy rates observed in this study allow us to present LASH as a safe and efficient alternative laparoscopic approach to remove uteri of any size in the hands of experienced surgeons.

Postoperative patient satisfaction after laparoscopic supracervical hysterectomy

This study demonstrates a high degree of postoperative patient satisfaction after laparoscopic supracervical hysterectomy.

Background and Objectives:

The aim of this study was to evaluate postoperative patient satisfaction in women after laparoscopic supracervical hysterectomy (LASH).

Methods:

A retrospective study by a mailed questionnaire among 2334 women who underwent hysterectomy via LASH at the MIC-Klinik, Berlin, between 1998 and 2004 was conducted. Indications for LASH were uterus myomatosus, adenomyosis uteri, disorders of bleeding, and genital descensus. The LASH operation technique was standardized and remained consistent throughout the observation period. Pearson's test for metric variables, Spearman's rank correlation test for ordinal data, Mann-Whitney U test, and Kruskal-Wallis test were used.

Results:

Of the 2334 questionnaires mailed, 1553 were returned and 1431 (61.3%) of those could be analyzed. Almost 94% (93.9%) of the women were highly satisfied with the outcome, 5.6% reported medium satisfaction, and 0.5% were not satisfied. There was no significant difference in patient satisfaction with regard to the different indication for LASH.

Conclusion:

This study demonstrates high postoperative patient satisfaction after LASH. The rate of highly satisfied women might be increased by carefully choosing the right indications for LASH and improving operation techniques. This is important for widening acceptance of this innovative new operation standard.

Alteration of sexual function after classic intrafascial supracervical hysterectomy and total hysterectomy

STUDY OBJECTIVE

To investigate possible advantages of classic intrafascial supracervical hysterectomy (CISH) over total hysterectomy with respect to sexual function.

DESIGN

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

SETTING

Department of obstetrics and gynecology at a university teaching hospital.

PATIENTS

One hundred eight women who had undergone CISH and 125 who had total hysterectomy.

INTERVENTION

A standard questionnaire sent to all 233 patients a minimum of 12 and maximum of 24 months after hysterectomy.

MEASUREMENTS AND MAIN RESULTS

Data obtained on sexual function were classified by changes (improved, no change, deteriorated) before and after hysterectomy. No significant difference was found between groups in mean time interval between surgery and first intercourse. Overall, over two-thirds of women experienced either no change or improvement in sexual function regardless of which procedure was performed, with no statistically significant differences in changes in libido, frequency of coitus, frequency of orgasm, and degree of orgasm.

CONCLUSIONS

Women who underwent CISH and total hysterectomy had no statistically significant differences with regard to postoperative sexual function.

Laparoscopic supracervical hysterectomy

Supracervical hysterectomy is a viable alternative for those individuals requiring uterine extirpation without indications for cervical removal. The laparoscopic approach to this procedure provides even lower morbidity and therefore can enhance clinical outcomes. The procedure is versatile in that most patients are amenable pathologically to this approach, particularly those individuals with large lieomyomata. Five year follow-up data is presented on 236 cases performed by the author including clinical outcomes and morbidity information. The procedure as performed by the author is presented in detail with illustrations of critical aspects of the technique of LSH.

Supravaginal uterine amputation in Denmark 1978-1988 and risk of cancer

In Denmark, total rather than subtotal hysterectomy has been recommended as treatment for benign conditions of the uterine corpus, primarily due to the risk of cervical cancer in the residual stump. Due to possible benefits during and after surgery, it has recently been argued that total hysterectomy for benign conditions could be substituted by subtotal hysterectomy, particularly since cancers of the cervix are declining as a consequence of screening. Cancer risk following supravaginal uterine amputation among 1104 Danish women undergoing operations during 1978-1988 was studied using record linkage techniques with the Danish Cancer Registry. No overall cancer risk, nor an overall increased risk of cancers coded as cervical, was observed. However, a 3.3 to 5.0-fold increased risk for cervical cancer was observed among women whose operations occurred at 50 years of age or older, possibly reflecting an increased risk of cancer in the endocervical area or in remaining uterine tissue. This observation, together with the difficulties in treating a cervical cancer of the stump when it does occur, should be taken into account before a change in surgical procedures from total to subtotal hysterectomies is recommended.