Removal of the retained cervical stump (original) (raw)
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Open Journal of Obstetrics and Gynecology
Background and Objectives: The supracervical hysterectomy (SCH) has resulted in a group of patients with a retained cervix at risk of persistent symptoms, who may require a trachelectomy in the future. This study was to evaluate the efficacy of vaginal trachelectomy (VT) after a previous SCH. Methods: This was a prospective study that includes 13 cases with different ages and different complaints, sharing the same primary operation supracervical hysterectomy. They have different pathologies of the SCH specimen but they share the same completion surgery. The surgical outcome was analyzed. Results: Thirteen patients underwent vaginal trachelectomy for recurrent symptoms. The ages of patients were ranged from 37 years to 68 years (Mean ± SD, 56.4 ± 10.7). SCH was most commonly performed for abnormal uterine bleeding AUB (7/13, 53.8%), pelvic mass (5/1, 38.5%), and pelvic pain (1/13, 7.7%), the symptoms leading to vaginal trachelectomy were the same as those leading to supracervical hysterectomy. The median interval time from SCH to seeking medical help for the persistence or recurrence of symptoms and to VT was 2 weeks (1 to 96 weeks). Concomitant procedures were laparoscopic removal of both ovaries in 2 cases and pelvic lymphadenectomy in 1 case. The median length of operation was 45 minutes. In all cases, symptoms leading to trachelectomy resolved completely after surgery, and patients reported a significant improvement. Conclusions: The cervix, left behind at subtotal hysterectomy, requires removal, the vaginal route is probably the safest, and least traumatic. Vaginal radical trachelectomy appears to be feasible and safe for the treatment of endometrial malignancy discovered after supracervical hysterectomy.
A Decade of Experience with Radical Abdominal Trachelectomy after Supracervical Hysterectomy
Background: The supracervical hysterectomy is no longer indicated for the treatment of female genital disease. Patient and Methods: All women who had trachelectomy after supracervical hysterectomy between 2010 and 2020 had their records reviewed at Cairo University's National Cancer Institute (NCI) Hospital. Results: A total of 34 trachelectomy surgeries were performed during a ten-year period. The patients were 42 to 72 years old, with a mean +SD of 55+7.5. Recurrent vaginal bleeding was the reason for trachelectomy in 67.6% of cases due to residual disease found in hysterectomy specimens, with pathologic evidence of uterine malignancy in 47.2%, and 11.7 percent of patients had cervical malignancy. Uterine stromal sarcoma was found in 5.9% of the cases. There were 11.8% of cases with uterine fibroids, 7.8% with endometrial hyperplasia, and 2.9 % with uterine adenomyosis who had true benign lesions. There were no pathology reports available in 8.8% of the cases. The pathology of the trachelectomy revealed that 26.5% of patients had no residual disease, while 73.5% had the residual disease in the cervical stump, with 32.4% having cervical squamous cell carcinoma, 20.6% having uterine adenocarcinoma, 8.8% having cervical adenocarcinoma, and 2.9% having cervical adenosquamous. Mullerian carcinoma was found in 2.9% of the cases, whereas undifferentiated carcinoma was found in 2.9%. In 61.8% of cases, bilateral pelvic lymphadenectomy was coupled with trachelectomy for radical excision of gross malignancy. Conclusions: A significant number of patients who had a subtotal hysterectomy for apparent benign illness required trachelectomy within a few months.
Archives of Gynecology and Obstetrics
Purpose The rates of hysterectomy are falling worldwide, and the surgical approach is undergoing a major change. To avoid abdominal hysterectomy, a minimally invasive approach has been implemented. Due to the increasing rates of subtotal hysterectomy, we are faced with the following questions: how often does the cervical stump have to be removed secondarily, and what are the indications? Methods This was a retrospective, single-centre analysis of secondary resection of the cervical stump conducted from 2004 to 2018. Results Secondary resection of the cervical stump was performed in 137 women. Seventy-four percent of the previous subtotal hysterectomy procedures were performed in our hospital, and 26% were performed in an external hospital. During the study period, 5209 subtotal hysterectomy procedures were performed at our hospital. The three main indications for secondary resection of the cervical stump were prolapse (31.4%), spotting (19.0%) and cervical dysplasia (18.2%). Unexpec...
Obstetrics & Gynecology Science
ObjectiveTo evaluate the feasibility, safety, and surgical outcomes of laparoscopic trachelectomy after supracervical hysterectomy.MethodsThis multicenter study was conducted at Tanta University, Benha University, and Aminah Laparoscopy Center (Benha, Egypt) from June 1, 2018 to October 31, 2021. Forty patients were recruited for this study and counseled on laparoscopic trachelectomy to treat their symptoms after supracervical hysterectomy. Furthermore, cervical biopsy was performed to detect and exclude any malignancy. Histopathological examination of cervical specimens was performed after surgery. Operative details and outcomes were recorded.ResultsThe median age of the patients was 42 years (range, 38-47). The median body mass index was 25 years (range, 22- 28). The median interval between hysterectomy and the clinical presentation was 4.40 years (range, 3.58-5.25). Most patients presented with abnormal vaginal discharge (40%) and bleeding (25%). Moreover, a cervical biopsy resul...
Robotic Trachelectomy After Supracervical Hysterectomy for Benign Gynecologic Disease
JSLS : Journal of the Society of Laparoendoscopic Surgeons, 2016
Background and Objectives: A renewed interest in the supra cervical approach to hysterectomy has created a cohort of patients with a retained cervix at risk of persistent symptoms requiring a subsequent trachelectomy. The objective of this study was to evaluate the efficacy of robotic trachelectomy after a previous supracervical hysterectomy. Methods: This is a retrospective chart review of women who had robotic trachelectomy after supracervical hysterectomy for benign gynecologic disease from January 2009 through October 2014. Results: Eleven patients underwent robotic trachelectomy for benign conditions during the observed period. Prior supracervical hysterectomy had been performed for pelvic pain (8/11, 73%), abnormal uterine bleeding (7/11, 64%), and dysmenorrhea (5/11, 45%). In 10 of 11 patients, the symptoms leading to robotic trachelectomy were the same as those leading to supracervical hysterectomy. The time from hysterectomy to recurrence of symptoms ranged from 0.5 to 26 months (median, 6), whereas the time interval from previous surgery to robotic trachelectomy ranged from 1 to 57 months (median, 26). Mean age and body mass index at robotic trachelectomy were 42 Ϯ 5.4 years and 32 Ϯ 6.1 kg/m 2. Mean length of surgery was 218 Ϯ 88 minutes (range, 100-405). There was 1 major postoperative complication involving bladder perforation and subsequent vesicovaginal fistula (VVF). Endometriosis was seen in 27% of pathologic specimens and cervicitis in another 27%; 45% showed normal tissue histology. In 6 (55%) cases, symptoms leading to trachelectomy resolved completely after surgery, and the other 5 (45%) patients reported a significant improvement. Conclusions: Although trachelectomy can be a challenging surgery, our experience suggests that the robotic approach may be a valuable means of achieving safe and reproducible outcomes.
Radical Vaginal Hysterectomy and Trachelectomy in Early-Stage Cervical Cancer
Open Journal of Obstetrics and Gynecology, 2014
Objective: To communicate a minimally invasive technique for surgical handling of early-stage cervical cancer and its results. Methods: 110 patients with cervical cancer in stages IA2 and IB1, all of them operated in a period of 5 years in both hospitals, are presented. Laparoscopic systemic pelvic lymphadenectomy with radical vaginal hysterectomy or radical vaginal trachelectomy was performed to patients, with the exception of those patients who had compromised nodes detected in contemporary biopsy. Results: Between April 2008 and May 2013, 110 patients were submitted to this technique. 15 patients had their surgery aborted: 13 presented positive nodes for carcinoma in contemporary biopsy and 2 had extensive cervical compromise when performing radical vaginal hysterectomy or trachelectomy. Analysis of the remaining 95 cases shows an average age of 43.9 years (26-61), all of them had given birth before, 23 (21%) of them through C-section. BMI averaged 30.5 and 31 (28.2%) had cone surgery performed previously. Average duration of surgery was of 220 minutes. Postoperative hospitalization averaged 3.1 days. Bleeding volume was estimated at 125 cc and one patient required blood transfusion. En 25 patients' uterine annexes were kept and all of them were suspended by means of laparoscopy. On average, 25.4 pelvic nodes were obtained. Complications 13.6% with eight patients suffered bladder injury, two had rectovaginal fistula, 3 patients requires surgical repair of ureteral obstruction, two patients present thromboembolic disease. The disease-free and overall survivals are consistent with reports in the literature. Conclusion: We believe that handling patients with this technique is possible and has the advantages of vaginal and laparoscopic surgery with minimal complications.
Radical vaginal trachelectomy (Dargent's operation): A critical review of the literature
European Journal of Surgical Oncology (EJSO), 2007
Aims: To present a review of the most recent articles about radical vaginal trachelectomy (RVT). Methods: Recent literature has been reviewed, concentrating on surgical, oncological and obstetrical outcome of RVT. Data for this review were identified by searches of PubMed, and references from relevant articles using the search terms ''trachelectomy'' and ''radical vaginal trachelectomy'', ''cervical carcinoma'', and ''fertility saving''. Findings: Although a considerable number of women in their reproductive years have been diagnosed with cervical carcinoma, conservative management of early-stage cervical carcinoma did not come into practice until the beginning of the new millennium. To date, 7 gynecologic oncologic centers worldwide have reported oncological and pregnancy outcomes since Dargent made his first announcement of radical vaginal trachelectomy (RVT) in 1994. Recurrence and death rates (4.2% and 2.8%, respectively) of RVT seem to be comparable to classical radical abdominal hysterectomy. It appears that RVT's overall recurrence and death rates were similar to early-stage cervical cancer treated by radical hysterectomy (RH) or radiotherapy. Furthermore fertility results of RVT seem to be promising. A 70% pregnancy rate was reported in the women who wanted to conceive following RVT, though such patients should be informed about the risk of second trimester loss and preterm delivery. On the other hand, there is a lack of satisfactory information about the follow-up of post-RVT patients, both after the operation and during subsequent pregnancy. Conclusion: RVT looks as if it is a valid uterus-conserving surgery for women of reproductive age who have early-stage cervical carcinoma. However, in order to reach a final conclusion about the oncological and obstetrical results, further studies are needed with larger sample sizes and longer follow-up periods.
Menopausal Review
Introduction: To review the malignant potential of the stump after subtotal abdominal hysterectomy. Material and methods: Thirty-three patients with stump malignancy were diagnosed and treated between January 2018 and January 2022. All patients primarily underwent subtotal hysterectomy (STH) outside our hospital due to different indications, most of which seemed non-convincing. Upon presentation, they were evaluated properly and offered the best management plan. Results: The presenting symptoms were abnormal histopathology report in 8 patients (24.24%), abnormal bleeding in 7 patients (21.21%), and postcoital bleeding and abnormal Pap smear in 6 patients (18.18%). The primary site of malignancy was endometrial in 17 patients (51.51%), on top of fibroid in 6 patients (18.18%), and cervical in 5 patients (15.15%). Eighteen patients (54.54%) underwent proper surgery, 9 patients (27.277%) were referred for chemoradiation, and 6 patients (18.18%) were candidates for palliative therapy. Conclusions: Stump cancer cases show a worse stage silhouette compared with cancer cases in intact uteruses. The high prevalence of cervical stump problems should be taken into account before a change in surgical approach from total to STH is deemed possible. Further prospective studies with prolonged follow-up periods are needed to evaluate the risks and benefits of retaining the cervix at hysterectomy. Subtotal hysterectomy is easier, does not require distinct skills that lead to experience and follow-up, and must be limited to the narrowest limits of practice, provided that the woman knows that there are no health benefits to keeping the cervix in place.