Laparoscopic Supracervical Hysterectomy
Hysterectomy is one of the most common surgical procedures performed in the United States. It is done for a variety of reasons including fibroids, which are benign tumors of the uterus, uncontrolled menstrual bleeding, and pelvic pain, as well as other indications.
Hysterectomies are performed in a number of different ways. The traditional abdominal hysterectomy is done through either a small “bikini” type incision through the lower abdomen or occasionally an incision that’s made from the bellybutton down to the pubic bone in the middle. When a hysterectomy is performed in this manner the patient does experience significant discomfort from the incision itself and the general recuperation time is approximately six weeks. A smaller number of hysterectomies in the United States are done through the vagina. In a vaginal hysterectomy, the uterus is removed through the vagina starting with the cervix and then disconnecting the remainder of the uterus after which the uterus is removed through the vagina. This surgery is generally better tolerated than the abdominal type and patients have approximately a four-week recovery with less pain.
Because not all patients are candidates for vaginal hysterectomy, surgeons in the 1980s developed the laparoscopically-assisted vaginal hysterectomy (LAVH) so that patients who otherwise would not be able to have a vaginal hysterectomy could have that procedure and benefit from a more prompt recovery.
In the laparoscopically-assisted hysterectomy, some of the surgical procedure is done through the bellybutton and through small holes in the abdomen, through which instruments are placed to perform the surgery of detaching the uterus from its internal connections. At the conclusion of the laparoscopic work, the remainder of the procedure is done in the usual fashion through the vagina. Recovery is generally the same as for traditional vaginal hysterectomy with a recovery time of approximately four weeks. When hysterectomies were first performed, they were generally done by removing the uterus alone and leaving the cervix (the portion of the uterus that extends into the vagina) behind. This allowed a quicker operation with fewer complications.
Nevertheless, at that time, approximately 100 years ago, cervical cancer was a significant problem and one of the most common causes of cancer death in women. With improved surgical techniques and anesthesia, surgeons popularized the notion of removing the cervix with the uterus in every hysterectomy and for the. past 70 to 80 years almost all hysterectomies involved the removal of the cervix. The development of the Pap smear in the 1930s helped reduce the incidence of cervical cancer to the point where it is now a somewhat uncommon cancer in women. This has caused surgeons to rethink the notion of removing the cervix with every hysterectomy. The cervix is the principal support point for the vagina and also contains nerves which pass through the cervix to the bottom of the bladder and the upper part of the vagina. Sparing the cervix at the time of hysterectomy has been thought to decrease complications, as well as possibly to preserve sexual and bladder functioning and pelvic support. The newer advances of laparoscopic surgery which were developed with the laparoscopicallyassisted vaginal hysterectomy have allowed us to perform all of the hysterectomy procedure through the bellybutton and small incisions on the tummy wall. The difficulty remained in how to remove the uterus after it had been detached from the cervix. Technological advances have now provided equipment that allow the removal of the entire uterus as well as fibroid tumors and other tissue from the abdomen through the bellybutton. This has led to the development of the laparoscopic supracervical hysterectomy (LASH).
In our practice we have performed many of these procedures and have noted that this method tends to involve less surgery, more prompt recovery, less discomfort, and diminished blood loss. The procedure can be done for a relatively wide range of problems and most of our patients who require hysterectomy have been able to choose the laparoscopic supracervical hysterectomy. Our recovery times have ranged from one to two weeks and because of the lack of need for pelvic repair, these patients can safely return to their full activity schedule without undue worry about weakening repairs postoperatively. As with all surgical procedures or approaches there are certain risks as well as benefits. For the patients in whom this is an appropriate option, your surgeon can review with you the advantages and disadvantages of the laparoscopic supracervical hysterectomy.
