Hysterectomy pp 467-480 | Cite as

Laparoscopic Subtotal Hysterectomy (LSH)

  • Bernd Bojahr
  • Garri Tchartchian


The aim of this article is to demonstrate a standardized safe minimal invasive technique of laparoscopic subtotal hysterectomy developed at the Clinic for Minimal Invasive Surgery in Berlin, Germany. Based on the experience of 11,598 LSH operations, the tips and tricks should help to prevent complications even in difficult case situations of very enlarged uteri. The “change over technique” is one way to prevent an abdominal hysterectomy in such cases. Our results regarding complication rates with the described surgical technique are compared and discussed with the literature.


Laparoscopic Subtotal Hysterectomy (LSH) Minimal Invasive Surgery Total Laparoscopic Hysterectomy (TLH) Vaginal Hysterectomy Severe Adhesive Disease 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Hucke J, DeBruyne F, Wangsatimur BR, Campo RL. Surgical hysteroscopy. Gynäkologie. 1993;26:338–45.Google Scholar
  2. 2.
    Mettler L. Endoskopische Abdominalchirurgie in der Gynäkologie. Stuttgart: Schattauer; 2002.Google Scholar
  3. 3.
    Semm K. Total ablation of uterine mucosa (TUMA) – CURT instead of endometrium ablation. Geburtshilfe Frauenheilkd. 1992;52:773–7.CrossRefPubMedGoogle Scholar
  4. 4.
    Bojahr B, Raatz D, Schonleber G, Abri C, Ohlinger R. Perioperative complication rate in 1706 patients after a standardized laparoscopic supracervical hysterectomy technique. J Minim Invasive Gynecol. 2006;13:183–9.CrossRefPubMedGoogle Scholar
  5. 5.
    Kilkku P, Grönroos M, Hirvonen T, Rauramo L. Supravaginal uterine amputation vs. hysterectomy. Effects on libido and orgasm. Acta Obstet Gynecol Scand. 1983;62(2):147–52.CrossRefPubMedGoogle Scholar
  6. 6.
    Thomas B, Magos A. Subtotal hysterectomy and myomectomy – Vaginally. Best Pract Res Clin Obstet Gynaecol. 2010;25(2):133–52. doi: 10.1016/j.bpobgyn.2010.11.003.CrossRefPubMedGoogle Scholar
  7. 7.
    Vervest HA, de Jonge M K, TM V, JW B, AA H. Micturition symptoms and urinary incontinence after non-radical hysterectomy. Acta Obstet Gynecol Scand. 1988;67(2):141–6.CrossRefPubMedGoogle Scholar
  8. 8.
    Gimbel H. Total or subtotal hysterectomy for benign uterine disease? A meta-analysis. Acta Obstet Gynecol Scand. 2007;86:133–44.CrossRefPubMedGoogle Scholar
  9. 9.
    Learman LA, Summit Jr RL, Varner RE, et al. A randomized comparison of total or supracervical hysterectomy: surgical complications and clinical outcomes. Obstet Gynecol. 2003;102:453–62.PubMedGoogle Scholar
  10. 10.
    Pasic R, Abdelmonem A, Levine R. Comparison of cervical detachment using monopolar lap loop ligature and conventional methods in laparoscopic supracervical hysterectomy. JSLS. 2006;10:226–30.PubMedPubMedCentralGoogle Scholar
  11. 11.
    Donnez O, Jadoul P, Squifflet J, Donnez J. A series of 3190 laparoscopic hysterectomies for benign disease from 1990 to 2006: evaluation of complications compared with vaginal and abdominal procedures. BJOG. 2009;116:492–500.CrossRefPubMedGoogle Scholar
  12. 12.
    Giep BN, Giep HN, Hubert HB. Comparison of minimally invasive surgical approaches for hysterectomy at a community hospital: robotic-assisted laparoscopic hysterectomy, laparoscopic-assisted vaginal hysterectomy and laparoscopic supracervical hysterectomy. J Robot Surg. 2010;4(3):167–75.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Tchartchian G, Dietzel J, Bojahr B, et al. No more abdominal hysterectomy for myomata using a new minimally-invasice technique. Int J Surg Case Rep. 2010;1(1):7–8.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Tchartchian G. Laparoscopic combined hysterectomy using the “Change Over Technique” for very large uterine myomata. In: Schollmeyer T, Mettler L, Rüther D, Alkatout I, editors. Practical manual for laparoscopic and hysteroscopic gynecological surgery. 2nd ed. New Delhi: Jaypee Brothers Medical Publishers; 2013. p. 337–41.Google Scholar
  15. 15.
    Dicker RC, Greenspan JR, Strauss LT, et al. Complications of abdominal and vaginal hysterectomy among women of reproductive age in the United States. The Collaborative Review of Sterilization. Am J Obstet Gynecol. 1982;144(7):841–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Härkki-Siren P, Sjöberg J. Evaluation and the learning curve of the first one hundred laparoscopic hysterectomies. Acta Obstet Gynecol Scand. 1995;74(8):638–41.CrossRefPubMedGoogle Scholar
  17. 17.
    Wang PH, Lee WL, Yuan CC, et al. Major complications of operative and diagnostic laparoscopy for gynecologic disease. J Am Assoc Gynecol Laparosc. 2001;8(1):68–73.CrossRefPubMedGoogle Scholar
  18. 18.
    Daraï E, Soriano D, Kimata P, et al. Vaginal hysterectomy for enlarged uteri, with or without laparoscopic assistance: randomized study. Obstet Gynecol. 2001;97(5 Pt 1):712–6.PubMedGoogle Scholar
  19. 19.
    Sarmini OR, Lefholz K, Froeschke HP. A comparison of laparoscopic supracervical hysterectomy and total abdominal hysterectomy outcomes. J Minim Invasive Gynecol. 2005;12:121–4.CrossRefPubMedGoogle Scholar
  20. 20.
    Buchele B. Retrospective analysis of 195 laparoscopic supracervical hysterectomies. J Am Assoc Gynecol Laparosc. 2004;11(suppl):S22.CrossRefGoogle Scholar
  21. 21.
    Fiaccavento A, Landi S, Barbieri F, et al. Total laparoscopic hysterectomy in cases of very large uteri: a retrospective comparative study. J Minim Invasive Gynecol. 2007;14:559–63.CrossRefPubMedGoogle Scholar
  22. 22.
    Hoffman CP, Kennedy J, Borschel L, et al. Laparoscopic hysterectomy: the Kaiser Permanente San Diego experience. J Minim Invasive Gynecol. 2005;12:16–24.CrossRefPubMedGoogle Scholar
  23. 23.
    Johnson N, Barlow D, Lethaby A, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2006;19:CD003677.Google Scholar
  24. 24.
    Garry R, Fountain J, Mason S, Hawe J, Napp V, Abbott J, et al. The eVALuate study: two parallel randomized trials, one comparing laparoscopic with abdominal hysterectomy, the other comparing laparoscopic with vaginal hysterectomy. BMJ. 2004;328:1229–36.CrossRefGoogle Scholar
  25. 25.
    Cipullo L, De Paoli S, Fasolino L, Fasolino A. Laparoscopic supracervical Hysterectomy Compared to Total Hysterectomy. JSLS. 2009;13:370–5.PubMedPubMedCentralGoogle Scholar
  26. 26.
    Bojahr B, Tchartchian G, Ohlinger R. Laparoscopic Supracervical Hysterectomy: a Retrospective Analysis of 1000 Cases. JSLS. 2009;13:129–34.PubMedPubMedCentralGoogle Scholar
  27. 27.
    Lyons TL. Laparoscopic supracervical versus total hysterectomy. J Minim Invasive Gynecol. 2007;14:275–7.CrossRefPubMedGoogle Scholar
  28. 28.
    Härkki-Siren P, Sjöberg J, Tiitinen A. Urinary tract injuries after hysterectomy. Obstet Gynecol. 1998;9:113–8.CrossRefGoogle Scholar
  29. 29.
    Jelovsek JE, Chiung C, Chen G, et al. Incidence of lower urinary tract injury at the time of total laparoscopic hysterectomy. JSLS. 2007;11:422–7.PubMedPubMedCentralGoogle Scholar
  30. 30.
    Johns A. Supracervical versus total hysterectomy. Clin Obstet Gynecol. 1997;40:903–13.CrossRefPubMedGoogle Scholar
  31. 31.
    Richards SR, Simpkins S. Laparoscopic supracervical hysterectomy versus laparoscopic-assisted vaginal hysterectomy. J Am Assor Gynecol Laparosc. 1995;2:431–5.CrossRefGoogle Scholar
  32. 32.
    Brummer TH, Seppälä TT, Härkki PS. National learning curve for laparoscopic hysterectomy and trends in hysterectomy in Finland 2000–2005. Hum Reprod. 2008;23:840–5.CrossRefPubMedGoogle Scholar
  33. 33.
    Harmanli OH, Tunitsky E, Esin S. A comparison of short-term outcomes between laparoscopic supracervical and total hysterectomy. Am J Obstet Gynecol. 2009;201:536.e1–7.CrossRefGoogle Scholar
  34. 34.
    Karaman Y, Bingol M, Günenc Z. Prevention of complications in laparoscopic hysterectomy: experience with 1120 cases performed by a single surgeon. J Minim Invasive Gynecol. 2007;14:78–84.CrossRefPubMedGoogle Scholar
  35. 35.
    Donnez O, Donnez J. A series of 400 laparoscopic hysterectomies for benign disease: a single centre, single surgeon prospective study of complications confirming previous retrospective study. BJOG. 2010;117:752–5.CrossRefPubMedGoogle Scholar
  36. 36.
    Lyons TL, Adolph AJ, Winer WK. Laparoscopic supracervical hysterectomy for the large uterus. J Am Assoc Gynecol Laparosc. 2004;11(2):170–4.CrossRefPubMedGoogle Scholar
  37. 37.
    Okaro EO, Jones KD, Sutton C. Long term outcome following laparoscopic supracervical hysterectomy. BJOG. 2001;108:1017–20.PubMedGoogle Scholar
  38. 38.
    Hutchins FLJ, Reinoehl EM. Retained myoma after laparoscopic supracervical hysterectomy with morcellation. J Am Assoc Gynecol Laparosc. 1998;5:293–5.CrossRefPubMedGoogle Scholar
  39. 39.
    Ghomi A, Littman P, Prasad A, Einarsson JI. Assessing the learning curve for laparoscopic supracervical hysterectomy. JSLS. 2007;11(2):190–4.PubMedPubMedCentralGoogle Scholar
  40. 40.
    Lyons TL. Laparoscopic supracervical hysterectomy. Obstet Gynecol Clin North Am. 2000;27:441–50.CrossRefPubMedGoogle Scholar
  41. 41.
    Mettler L, Semm K, Lehmann-Willenbrock L, Shah A, et al. Comparative evaluation of classical intrafascial-supracervical hysterectomy (CISH) with transuterine mucosal resection as performed by pelviscopy and laparotomy – our first 200 cases. Surg Endosc. 1995;33:448–53.Google Scholar
  42. 42.
    Mettler L. Long-term results in the treatment of menorrhagia and hypermenorrhea with a thermal balloon endometrial ablation technique. JSLS. 2002;6:305–9.PubMedPubMedCentralGoogle Scholar
  43. 43.
    Reich H, McGlynn F, Sekal L. Total laparoscopic hysterectomy. Gynecol Endosc. 1993;2:59–63.Google Scholar
  44. 44.
    Mettler L, Ahmed-Ebbiary N, Schollmeyer T. Laparoscopic hysterectomy: Challenges and limitations. Minim Invasive Ther Allied Technol. 2005;14(3):145–59.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2018

Authors and Affiliations

  • Bernd Bojahr
    • 1
  • Garri Tchartchian
    • 1
  1. 1.Klinik für MIC Minimal Invasive ChirurgieBerlinGermany

Personalised recommendations