Long term outcome following laparoscopic supracervical hysterectomy (original) (raw)
Related papers
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...
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.
Long-Term Outcomes Following Laparoscopic and Abdominal Supracervical Hysterectomies
Obstetrics and Gynecology International, 2010
Long-term outcomes, in terms of cervical stump symptoms and overall patient satisfaction, were studied in women both after abdominal (SAH) and laparosocopic (LSH) supracervical hysterectomies. Altogether, 134 women had SAH and 315 women LSH during 2004 and 2005 at our department. The response rate of this retrospective study was 79%. Persistent vaginal bleeding after the surgery was reported by 17% in the SAH group and 24% in the LSH group. Regular bleeding was reported by only 8% in both study groups, and the women rarely found the bleeding bothersome. The women reported a significant pain reduction after the surgery, but women having a hysterectomy because of pain and/or endometriosis should be informed about the possibility of persistent symptoms. The overall patient satisfaction after both procedures was high, but the patients should have proper preoperative information about the possibility of cervical stump symptoms after any supracervical hysterectomy.
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.
Removal of the retained cervical stump
American Journal of Obstetrics and Gynecology, 2005
Objective: The purpose of this study was to identify indications for and complications of abdominal or vaginal surgical removal of the cervical stump after previous supracervical hysterectomy. Study design: This was a retrospective chart review of trachelectomy patients at Mayo Clinic, Rochester, Minnesota, or Mayo Clinic, Scottsdale, Arizona, between January 1974 and December 2003. Results: Of 335 patients with a history of supracervical hysterectomy who subsequently required trachelectomy, 25 were excluded from study. Half of the remaining 310 patients had trachelectomy between 1974 and 1983, an average of 26 years after hysterectomy. The indication in three quarters of trachelectomies performed vaginally was prolapse. The vaginal approach had significantly fewer complications than the abdominal approach. Conclusion: Removal of the cervical stump is infrequent and has declined over a 30-year period. The decline in trachelectomy may be because of a decreasing number of supracervical hysterectomies performed. When trachelectomy is performed vaginally, prolapse is the most common indication, and there are few complications.
Translational Cancer Research, 2021
Background: Cervical cancer is a common malignant tumor in women. This study aims to explore the clinical effects of traditional laparotomy, extensive vaginal hysterectomy and laparoscope-assisted vaginal hysterectomy in the treatment of patients with cervical intraepithelial neoplasia III (CIN III). Methods: A total of 79 cases with CIN III in situ who were treated in our hospital from July 2015 to February 2017 were selected as the study participants. According to the different surgical methods employed, patients were divided into a laparotomy group (n=21), a vaginal group (n=26), and a laparoscope-assisted vaginal group (n=32). The operative indicators in the three groups were compared, as well as the operative complications, quality of life, and female sexual function. Results: The operation time, intraoperative blood loss, and hospitalization time in the laparotomy group were all significantly greater than those in the vaginal and laparoscope-assisted vaginal groups (P<0.05), and the operative time was the shortest in the vaginal group. There was no significant difference in postoperative recovery time, drainage tube removal time, and time to out-of-bed activation between the vaginal group and the laparoscope-assisted vaginal group (P>0.05). After surgery, the main complications were poor wound healing, infection, vaginal discharge, and neoplasms of the vagina, and the total incidence of complications in the laparotomy group was 19.04%, which was significantly higher than that in the vaginal group (3.84%) and the laparoscope-assisted vaginal group (3.12%) (P<0.05). Three months after surgery, the physical and emotional function scores of patients in the laparoscope-assisted vaginal group were significantly higher than those in the laparotomy and vaginal groups (P<0.05). Six months after surgery, there were no significant differences among the three groups in scores of libido, sexual intercourse pain, orgasm, or difficulty in sexual intercourse (P>0.05). Conclusions: Laparoscope-assisted vaginal hysterectomy has a short recovery time and a low incidence of complications in patients with early cervical cancer in situ. Compared with laparotomy and vaginal hysterectomy, laparoscope-assisted vaginal hysterectomy is more conducive to improving the postoperative quality of life of patients.
European Journal of Obstetrics & Gynecology and Reproductive Biology, 2001
Objective: hysterectomy for benign disorders is usually well tolerated, but complications do occur. The aim of this retrospective study is to document such complications. Patients and methods: between March 1991 and December 1998, 1604 patients (mean age: 46 years) underwent hysterectomy for benign disorders. Peroperative and early postoperative complications were recorded for the 1248 vaginal hysterectomies (8%), 190 laparoscopically assisted vaginal hysterectomies (12%), and 166 abdominal hysterectomies (10%). Results: none of the patients died. There were 15 bladder (0.9%) and one ureter injury (0.06%) with no signi®cant difference between routes. Intestinal injuries (0.6%) overall were more common when laparotomy was performed (2.4%). In 45 patients (2.8%), bleeding exceeded 500 ml. The rates were vaginal hysterectomy (2%, P < 0:001), laparotomy (6.7%), and laparoscopy (5.3%). The overall reoperation rate of 0.8% does not differ with the type of the procedure. Conclusion: Per and early postoperative complications after hysterectomy remain important and patients should be aware of them. In order to control complications and decrease the morbidity, a high-risk population should be de®ned based on the patients' history of pelvic surgery and endometriosis, on their parity and the size of their uterus. For these patients, the most appropriate route should be preferred and complications should be assessed using different tests and subsequently treated during the same procedure. #
Long-Term Outcomes Following Laparoscopic Supracervical Hysterectomy
Obstetrical & Gynecological Survey, 2009
It is unclear whether the risk of persistent vaginal bleeding and pelvic pain following surgery is increased following laparoscopic supracervical hysterectomy (LSH) compared to total laparoscopic hysterectomy (TLH). In Norwegian women who underwent LSH, this retrospective study evaluated the occurrence of vaginal bleeding and pelvic pain, the toleration of residual symptoms, and overall satisfaction with the procedure through the use of a postal questionnaire during 2004 and 2005. Of a total of 315 consecutive patients contacted 12 to 36 months after surgery, 240 (78%) responded. Menstrual bleeding continued in 24% (57 women) but was considered minimal in 90% of the women; on a 10-point visual analogue scale (VAS), the mean bothersome score was 1.1 (SD 2.0). When only regular bleeding was included in the analysis, the percentage decreased from 24% to 8%. Women with a less experienced surgeon were more likely to report continued vaginal bleeding (P Ͻ 0.02). Of the 178 women (74%) with menstrual pain before LSH, up to 3 years after surgery, 89 women (38%) reported continued menstrual/cyclical pain. However, the pain was considerably less intense; the mean VAS-10 score before and after surgery was 6.8 (SD 2.05) and 3.5 (SD 2.16), respectively (P Ͻ 0.01). Significantly higher levels of residual menstrual/cyclical pain after surgery occurred among women reporting endometriosis as a reason for the hysterectomy compared with women who did not (P Ͻ 0.001). A total of 90% of the women were very satisfied (70%) or satisfied (20%) with the hysterectomy. These findings show a high level of patient satisfaction with LSH despite the relatively common occurrence of residual menstrual bleeding and pain.
A prospective comparison of vaginal stump suturing techniques during total laparoscopic hysterectomy
Archives of Gynecology and Obstetrics, 2009
Purpose We compared the incidence of vaginal cuV dehiscence and other surgical complications after diVerent modes of suturing during total laparoscopic hysterectomy (TLH), and reviewed the characteristics of patients with complications. Methods We enrolled 248 patients undergoing TLH for benign diseases at Daejeon St Mary's Hospital of Korea from March 2007 through February 2009. We evaluated the clinical outcomes of diVerent vaginal cuV suture techniques during TLH: the widely used interrupted Wgure-of-eight suture and a two-layer running suture. Results All operations were completed successfully by laparoscopy. Three of 248 hysterectomies (1.2%) were complicated by vaginal cuV dehiscence. One of them belonged to the two-layer running suture group, and the others belonged to the interrupted Wgure-of-eight suture group. However, there was no statistically signiWcant diVerence in outcomes between the suture methods. One case of trocar site incisional herniation occurred. No ureteral, bladder, or major vascular injury occurred. The overall major complication rate including vaginal bleeding was 2.0% (5/248). Conclusions The two-layer running suture technique was safe and eVective for vaginal cuV suture during TLH, but there was no statistically signiWcant advantage over the widely used Wgure-of-eight suture method. Diabetes, cigarette smoking and pelvic adhesions produced statistically signiWcant increased risks of complication.