Neoplasia cervical intraepitelial tipo III, poshisterectomía supracervical laparoscópica: ventajas e inconvenientes de la conservación del cuello uterino en pacientes histerectomizadas / Cervical intraepithelial neoplasia type III after laparoscopic supracervical hysterectomy. Advantages and disadvantages of cervical conservation in hysterectomized patients

Resumen ANTECEDENTES: Existen múltiples opciones para practicar una histerectomía: por vía vaginal, abdominal laparotómica, laparoscópica o robótica. En pacientes que van a intervenirse por enfermedad benigna puede hacerse mediante la extirpación del cuerpo uterino (histerectomía parcial o supracervical). La preocupación por la posible aparición de una lesión neoplásica en el muñón cervical remanente ha dado lugar a investigaciones acerca de las ventajas de la exéresis del cuello uterino (histerectomía total). CASO CLÍNICO: Paciente de 36 años, intervenida para histerectomía supracervical con salpingectomía bilateral laparoscópica, por útero miomatoso sintomático. Posterior a la cirugía apareció una lesión preneoplásica de alto grado; se le indicó conización cervical. CONCLUSIÓN: Algunos expertos advierten que los riesgos de extirpar el cuello uterino son lo suficientemente notables como para optar por la técnica parcial en pacientes sin antecedentes de patología cervical, sobre todo si tienen cuadros adherenciales o endometriosis del tabique rectovaginal. Por el contrario, otros grupos indican que ante la baja tasa de complicaciones de la histerectomía total y la posibilidad de una patología neoplásica posterior, no está justificada la preservación cervical.

Abstract BACKGROUND: There are multiple approaches to perform a hysterectomy; the classic vaginal route, the laparotomic abdominal or the newest endoscopic techniques, such as laparoscopic or robotic. In patients undergoing benign pathology, the technique can only be performed by removing the uterine body (subtotal or supracervical hysterectomy). However, the concern about the possible occurrence of a neoplastic lesion in the remaining cervical stump has led to investigations into the benefits of also performing the cervical exeresis (total hysterectomy). Our goal is to present a review on the current situation of the topic, concluding that there is still no scientific consensus on which technique is the most recommended. CLINICAL CASE: 36-year-old woman who underwent supracervical hysterectomy with laparoscopic bilateral salpinguectomy due to symptomatic myomatous uterus. After surgery, he presented a high-grade preneoplastic lesion, which indicated that cervical conization was indicated. CONCLUSION: Some experts argue that the risks of performing the removal of the cervix are notable enough to indicate subtotal technique in patients without a history of cervical pathology, especially if they have adhesion or endometriosis of the rectovaginal septum. On the contrary, other working groups indicate that cervical preservation is not justified due to the low complication rate of the total hysterectomy technique and the possibility of developing a subsequent neoplastic pathology.

Prevotella bivia Infection Following Supracervical Hysterectomy: Case Report with a Review of Literatures

Prevotella bivia (P. vivia) has a high proliferative potential in the presence of estrogen. Therefore, its involvement in vaginal tract infections, such as endometritis and pelvic inflammatory disease, has been well described in the literature. We experienced a very rare case of a 40-year old woman with a 6-cm abscess on the cuff who presented with a large amount of vaginal discharge and nausea two months after laparoscopic supracervical hysterectomy. Our case indicates that clinicians should be aware of the possibility of P. vivia infections although rare.

Patient Satisfaction, Vaginal Bleeding, Sexual Function following Laparoscopic Supracervical Hysterectomy

PURPOSE: This study was done to evaluate postoperative patient satisfaction, vaginal bleeding, and sexual function in women after laparoscopic supracervical hysterectomy (LSH). METHODS: A retrospective study was conducted using a questionnaire mailed to 131 women who underwent LSH between 2008 and 2011at the Department of Obstetrics &Gynecology, D University Hospital in Chungnam province. Indication for LSH was uterine myoma. The questionnaire contained questions on overall postoperative satisfaction, influence on quality of life of vaginal bleeding, and sexual satisfaction following surgery. Data were collected from March to July 2013 and 109 (83.2%) patients returned the questionnaire. RESULTS: Most women reported being very satisfied (90.8%) or satisfied (7.3%), but 2 women (1.8%) were not satisfied with LSH. Four patients (3.4%) reported experiencing vaginal bleeding but with no negative influence on quality of life. Of sexually active women, 82 patients (90.1%) reported improvements in sexual function, 8 patients (8.8%) reported "no change", and one patient (1.1%) reported a deterioration. CONCLUSION: Results of this study indicate that LSH is associated with a high degree of patient satisfaction, no negative influence on quality of life from vaginal bleeding, and improvement in sexual function to a minimum 2 years after the procedure.

Comparative study of laparoscopic assisted vaginal hysterectomy and laparoscopic supracervical hysterectomy / 대한산부인과학회지

OBJECTIVE: To compare the clinical results between laparoscopic assisted vaginal hysterectomy (LAVH) and laparoscopic supracervical hysterectomy (LSH) in women with uterine leiomyoma. METHODS: One hundred four women underwent laparoscopic hysterectomy for the treatment of uterine leiomyoma between July 2008 and December 2009. A total of 60 women decided to undergo complete hysterectomy with removal of uterine cervix (LAVH group) and 44 women wished to preserve the uterine cervix (LSH group). Outcome measures including patient's characteristics, operating time, blood loss, rate of complications, were assessed and compared between groups. RESULTS: The women in the LAVH group were significantly older as compared with the LSH group, 45.16+/-0.84 years versus 42.41+/-0.62 years respectively. There were no significant differences in patient's characteristics (body mass index, parity, prior surgery) between the two groups. The mean operating time was 64.07+/-2.37 min. for LAVH group and 69.76+/-2.01 min. for LSH group; the mean hemoglobin change was 1.62+/-0.13 g/dL for LAVH group, 1.83+/-0.14 g/dL for LSH group, no significant differences were noted between two groups respect to the mean operating time and the mean hemoglobin change. There is no post-operative complications in both LAVH and LSH group. CONCLUSION: Based on our results, in women with uterine leiomyoma, LAVH and LSH seem to be the preferred hysterectomy techniques. The mean age was younger in LSH group, but did not appear to offer any significant benefits over LAVH. LAVH proved to be a valid alternative to LSH, and appropriate method for laparoscopic hysterectomy.

Update in Laparoscopic Hysterectomy and Laparoscopic Myomectomy / 한양의대학술지

The role of laparoscopic hysterectomy (LH) in current gynecological practice has yet to be defined. Randomized trials have demonstrated that, compared to abdominal hysterectomy, LH shortens hospital stay and induces less postoperative pain and quicker recovery. Some retrospective publications it seems that complication rates have increased in LH, especially those involving the urinary system. However, a recent analysis revealed a reasonable complication rate for the procedure, compared with abdominal hysterectomy, Laparoscopic supracervical hysterectomy (LSH) is a minimally invasive procedure that was developed during the 1990s as a treatment for abnormal uterine bleeding. The literature regarding this procedure, mainly case series and retrospective comparisons, suggests that LSH results in reduced operating time and blood loss and a quicker return to normal activity, compared with laparoscopic-assisted vaginal hysterectomy (LAVH). Given the lack of appropriate randomized, controlled trials and the limitations of the existing research, the LSH's true value and appropriate clinical indications remain unknown Uterine fibroids are the most common benign tumors of the uterus. Management depends on the symptoms, location and size of the fibroids, and the patient's desire to conceive. Surgical management of uterine fibroids has changed from laparotomy to minimally invasive surgery. Advances in surgical instruments and techniques are expanding the role of laparoscopic myomectomy in well-selected ndividuals. Meticulous repair of the myometrium is essential for women considering pregnancy after laparoscopic myomectomy to minimize the risk of uterine rupture. Laparoscopic myomectomy is an appropriate alternative to abdominal myomectomy or hysterectomy.

Analysis of 34 Cases with Laparoscopic Supracervical Hysterectomy / 医学研究杂志

Objective To evaluate the clinical results of patients submitted to laparoscopic assisted supracervical hysterectomy for benign uterine disease.Methods Women referred for supracervical hysterectomy for benign uterine diseases were divided into laparoscopy group(n=34)or open group(n=30).The operative time,blood loss,complications,morbidity,ileus,wound infections were compared between the two groups.Results In terms of Operative time,both of total operative time and oophosalpingorectomy time,there was no significant difference between laparoscopic group and open group.Less blood loss was found in laparoscopic group than open group.No complications were found in both groups.Conclusions Laparoscopic assisted supracervical hysterectomy is a safer and easier approach to complete supracervical hysterectomy with reduced blood loss and quick convalescence.It can be successfully integrated into a large health maintenance organization/residency-training program.

Clinical Value of Laparoscopic Supracervical Hysterectomy / 中国微创外科杂志

Objective To explore the clinical value of laparoscopic supracervical hysterectomy (LSH). Methods From July 2006 to September 2007,78 cases of LSH and 59 cases of abdominal supracervical hysterectomy (ASH) were performed in our hospital. The clinical data of the patients,including intraoperative blood loss,operation time,recovery time of bowel movement,postoperative time of out-of-bed activity and postoperative hospital stay,were analyzed and compared between the two groups.Results No significant difference was found on the mean intraoperative blood loss between the LSH group and ASH group [(65.1?25.5) ml vs (72.9?23.6) ml,t=-1.830,P=0.069]. Whereas,the LSH group had significantly longer operation time and earlier recovery of the gastrointestinal function [(80.3?29.6) min vs (62.4?13.1) min,t=4.332,P=0.000;and (26.5?8.5) h vs (30.9?7.0) h,t=-3.232,P=0.001]. Furthermore,the LSH patients had out-of-bed activity and were discharged from hospital significantly earlier than the ASH group [(32.8?6.7) h vs (40.4?9.7)h,t=-5.421,P=0.000;and (7.1?0.6) d vs (7.9?0.5) d,t=-8.291,P=0.000]. No major complication occurred in both the groups. Conclusions LSH shows great advantages over ASH. As long as surgeons are skilled in laparoscopic operation,LSH can be an ideal procedure for hysterectomy.

Laparoscopic Hysterectomy for Large Uterus:A Report of 86 Cases / 中国微创外科杂志

Objective To investigate the operative skills of laparoscopic hysterectomy of large uterus.Methods A retrospective analysis was conducted on clinical data from 86 cases whose uterus were bigger than twelve gestational age uterus and therefore treated with laparoscopic hysterectomy from February 1998 to December 2005.Among the 86 cases,12 received total laparoscopic hysterectomy(TLH),59 received laparoscopic supracervical hysterectomy(LSH),and 15 received laparoscopic-assisted vaginal hysterectomy(LAVH).The location of laparoscopy was determined to be at least 3-5 cm above the fundus of uterus.The most crucial step was the treatment of adnexa and uterine blood vessels.After blocking the uterine blood vessels,most of uterine bodies were rotarily cut in TLH and LAVH.Results All operations(86 cases)were performed successfully under laparoscopy and no severe operative complications were noticed except for 1 case of subcutaneous emphysema.The average operation time and the intra-operative blood loss were(92.3 ?33.5)min and(113 ?31)ml respectively.The average postoperative hospital stay was(4.1?0.3)days.No postoperative complication was found in all cases during the 6-month follow-up.Conclusions Laparoscopic hysterectomy of large uterus is safe and feasible,and does not increase operative risk and incidence of complications,when suitable laparoscopic location is selected and treatments of adnexa and uterine vessel are well performed.

The effects of total and supracervical hysterectomy on sexual function / 대한산부인과학회지

OBJECTIVE: The aim of this study was to analyze the effects of total abdominal hysterectomy (TAH) versus supracervical hysterectomy (SCH) on sexual function in patients with non-malignant conditions. METHODS: We choose fifty patients who were operated by SCH and forty-six patients who were operated by TAH. They were interviewed that effects of the two operations on sexual desire, coital frequency, quality and frequency of orgasms, post-op development of dyspareunia and overall sexual satisfaction. RESULTS: 1. The sexual desire significantly decreased in TAH group compared with SCH group (46% vs 8%, P<0.001). And the coital frequency also decreased in TAH group (48% vs 6%, P<0.001). 2. Orgasm frequency and quality decreased in more patients with TAH compared with SCH (22% vs 2%, 33% vs 2%). 3. After SCH and TAH, there was no change in dyspareunia and significantly decreased sexual satisfaction was noted in TAH group (35% vs 4%). CONCLUSION: It suggest that TAH patients experienced worse postoperative sexual function than SCH patients. therefore, it should be considered to conserving the cervix at hysterectomy.

Clinical analysis of 740 cases of laparoscopic hysterectomy / 中国微创外科杂志

Objective To evaluate the clinical efficacy of four different methods of laparoscopic hysterectomy: laparoscopic supracervical hysterectomy(LSH),classic intrafascial supracervical hysterectomy(CISH),laparoscopic-assisted vaginal hysterectomy(LAVH),and total laparoscopic hysterectomy(TLH). Methods A retrospective analysis was carried out on 740 cases of laparoscopic hysterectomy in this hospital from January 1999 to December 2004 in respect of operating time,intraoperative blood loss,weight of removed uterus,postoperative recovery,time to normal sexual life,sexual satisfaction,and incidence of complications. Results The operations were accomplished under laparoscope in all the 740 cases.The operating time of LSH,CISH,TLH,and LAVH were 95.3?32.4 min,84.5?31.7 min,105.3?34.5 min,and 169.4?37.4 min,respectively.The time to normal sexual life of LSH,CISH,TLH,and LAVH were 30?5 d,50?9 d,35?7 d,and 54?11 d,respectively.The incidences of complications of LSH,CISH,TLH,and LAVH were 1.7%(2/120),1.3%(4/310),2.8%(7/250),and 1.7%(1/60),respectively. Conclusions Laparoscopic hysterectomy is safe and reliable.Of four methods of laparoscopic hysterectomy,each has its advantages and disadvantages,and method selection should be based on patient's own conditions.

A report of 65 cases of classical intrafascial supracervical hysterectomy / 中国微创外科杂志

Objective To explore the feasibility of classical intrafascial supracervical hysterectomy (CISH). Methods Clinical data of 65 cases of classical intrafascial supracervical hysterectomy were reviewed. Results The classical intrafascial supracervical hysterectomy was accomplished under laparoscope in all the 65 cases. The operation time was 110 7?29 9 min, and the intraoperative blood loss was 45 3?22 1 ml. No conversion to open surgery was required. No severe complication occurred. Conclusions Classical intrafascial supracervical hysterectomy demonstrates excellent safety, minimal invasion, less blood loss, and quick recovery to normal activities. Laparoscopy; Classical intrafascial supracervical hysterectomy