Hysterectomy pp 481-493 | Cite as

Laparoscopic Supracervical Hysterectomy for Large Uteri

  • Funlayo OdejinmiEmail author
  • Reeba Oliver


In recent years removing the uterus laparoscopically has become the method of choice to perform a hysterectomy. A supracervical hysterectomy has been shown to result in better intra operative and postoperative outcomes, although the evidence is less robust when analyzing procedures performed laparoscopically. Notwithstanding the above caveat, as cervical malignancy remains the only absolute contraindication to a supracervical hysterectomy, many of the perceived limitations to the procedure have been eroded. This includes the removal of large uteri, especially those weighing more than 500 g. Advances in endoscopic technology has enabled their removal, but published data on the procedure, the technique and its outcomes remain scarce.

We aim to present a consensus on the safety and feasibility of the laparoscopic supracervical hysterectomy for the large uteri from existing data as well as personal experience. We also aim to provide the surgical techniques and the various modalities and safeguards necessary to overcome the challenges inherent in this procedure.

Thus armed with reasonable endoscopic surgical skills, current advanced laparoscopic equipment and the knowledge to modify surgical techniques appropriately, the laparoscopic surgeon of today should be able to remove even large uteri laparoscopically and safely.


Laparoscopic supracervical hysterectomy Surgical technique 


  1. 1.
    Sutton C. Hysterectomy: a historical perspective. Baillieres Clin Obstet Gynaecol. 1997;11(1):1–22.CrossRefPubMedGoogle Scholar
  2. 2.
    Nieboer TE, Johnson N, Lethaby A, Tavender E, Curr E, Garry R, van Voorst S, Mol BW, Kluivers KB. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2009;3:CD003677. doi: 10.1002/14651858.CD003677.Google Scholar
  3. 3.
    Alperin M, Kivnick S, Poon KY. Outpatient laparoscopic hysterectomy for large uteri. J Minim Invasive Gynecol. 2012;19(6):689–94. doi: 10.1016/j.jmig.2012.06.007.CrossRefPubMedGoogle Scholar
  4. 4.
    Park SH, Cho HY, Kim HB. Factors determining conversion to laparotomy in patients undergoing total laparoscopic hysterectomy. Gynecol Obstet Invest. 2011;71(3):193–7. doi: 10.1159/000317520. Epub 2010 Dec 15.CrossRefPubMedGoogle Scholar
  5. 5.
    Benassi L, Rossi T, Kaihura CT, Ricci L, Bedocchi L, Galanti B, Vadora E. Abdominal or vaginal hysterectomy for enlarged uteri: a randomized clinical trial. Am J Obstet Gynecol. 2002;187(6):1561–5.CrossRefPubMedGoogle Scholar
  6. 6.
    Lethaby A, Vollenhoven B, Sowter M.Pre-operative GnRH analogue therapy before hysterectomy or myomectomy for uterine fibroids Cochrane Database Syst Rev 2001;(2):CD000547.Google Scholar
  7. 7.
    Ferrari MM, Berlanda N, Mezzopane R, Ragusa G, Cavallo M, Pardi G. Identifying the indications for laparoscopically assisted vaginal hysterectomy: a prospective, randomised comparison with abdominal hysterectomy in patients with symptomatic uterine fibroids. BJOG. 2000;107(5):620–5.CrossRefPubMedGoogle Scholar
  8. 8.
    Karaman Y, Bingol B, Günenç Z. Prevention of complications in laparoscopic hysterectomy: experience with 1120 cases performed by a single surgeon. J Minim Invasive Gynecol. 2007;14(1):78–84.CrossRefPubMedGoogle Scholar
  9. 9.
    Semm K. Hysterectomy via laparotomy or pelviscopy. A new CASH method without colpotomy. Geburtshilfe Frauenheilkd. 1991;51(12):996–1003.CrossRefPubMedGoogle Scholar
  10. 10.
    Berner E, Qvigstad E, Myrvold AK, Lieng M. Pain reduction after total laparoscopic hysterectomy and laparoscopic supracervical hysterectomy among women with dysmenorrhoea: a randomised controlled trial. BJOG. 2015;122(8):1102–11. doi: 10.1111/1471-0528.13362. Epub 2015 Apr 19.CrossRefPubMedGoogle Scholar
  11. 11.
    Lieng M, Lømo AB, Qvigstad E. Long-term outcomes following laparoscopic and abdominal supracervical hysterectomies. Obstet Gynecol Int. 2010;2010:989127. doi: 10.1155/2010/989127. Epub 2010 Mar 14.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Garry R. The place of subtotal/supracervical hysterectomy in current practice. BJOG. 2008;115(13):1597–600. doi: 10.1111/j.1471-0528.2008.01956.x.CrossRefPubMedGoogle Scholar
  13. 13.
    Lyons TL. Laparoscopicsupracervical hysterectomy. A comparison of morbidity and mortality results with laparoscopically assisted vaginal hysterectomy. J Reprod Med. 1993;38(10):763–7.PubMedGoogle Scholar
  14. 14.
    Lethaby A, Mukhopadhyay A, Naik R. Total versus subtotal hysterectomy for benign gynaecologicalconditions. Cochrane Database Syst Rev. 2012;4:CD004993. doi: 10.1002/14651858.CD004993.pub3.Google Scholar
  15. 15.
    Tchartchian G, Gardanis K, Bojahr B, de Wilde L. Postoperative patient satisfaction after laparoscopic supracervical hysterectomy. JSLS. 2013;17:107–10.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Lieng M, Qvigstad E, Istre O, Langebrekke A, Ballard K. Long-term outcomes following laparoscopicsupracervical hysterectomy. BJOG. 2008;115:1605–10.CrossRefPubMedGoogle Scholar
  17. 17.
    Hussain M, Odejinmi F. Laparoscopic supracervicalhysterectomy:impact of body mass index and uterineweight. Gynecol Surg. 2012;9:351–5. doi: 10.1007/s10397-011-0721-5.CrossRefGoogle Scholar
  18. 18.
    Darai E, Soriano D, Kimata P, et al. Vaginal hysterectomy for enlarged uteri, with or without laparoscopic assistance: randomised study. Obstet Gynecol. 2001;97:712–6.PubMedGoogle Scholar
  19. 19.
    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
  20. 20.
    Maclaran K, Agarwal N, Odejinmi F. Perioperative outcomes in laparoscopic hysterectomy: identifying surgical risk factors. Gynecol Surg. 2015;13:75. doi: 10.1007/s10397-015-0914-4.CrossRefGoogle Scholar
  21. 21.
    Grosse-Drieling D, Schlutius JC, Altgassen C, Kelling K. ThebenJ.Laparoscopicsupracervical hysterectomy (LSH), a retrospective study of 1,584 cases regarding intra- and perioperative complications. Arch Gynecol Obstet. 2012;285(5):1391–6. doi: 10.1007/s00404-011-2170-9. Epub 2011 Dec 16.CrossRefPubMedGoogle Scholar
  22. 22.
    Bojahr B, Tchartchian G, Ohlinger R. Laparoscopic supracervical hysterectomy: a retrospective analysis of 1000 cases. JSLS. 2009;13(2):129–34.PubMedPubMedCentralGoogle Scholar
  23. 23.
    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
  24. 24.
    Twijnstra AR, Blikkendaal MD, van Zwet EW, Jansen FW. Clinical relevance of conversion rate and its evaluation in laparoscopic hysterectomy. J Minim Invasive Gynecol. 2013;20(1):64–72. doi: 10.1016/j.jmig.2012.09.006.CrossRefPubMedGoogle Scholar
  25. 25.
    Leonard F, Chopin N, Borghese B, Fotso A, Foulot H, Coste J, Mignon A, Chapron C. Total laparoscopic hysterectomy: preoperative risk factors for conversion to laparotomy. J Minim Invasive Gynecol. 2005;12(4):312–7.CrossRefPubMedGoogle Scholar
  26. 26.
    Shahid A, Sankaran S, Odejinmi F. Laparoscopic subtotal hysterectomy for large uteri using modified five port technique. Arch Gynecol Obstet. 2011;283(1):79–81. doi: 10.1007/s00404-009-1322-7. Epub 2009 Dec 19.CrossRefPubMedGoogle Scholar
  27. 27.
    Nimaroff ML, Dimino M, Maloney S. Laparoscopic-assisted vaginal hysterectomy of large myomatous uteri with supracervical amputation followed by trachelectomy. J Am Assoc Gynecol Laparosc. 1996;3(4):585–7.CrossRefPubMedGoogle Scholar
  28. 28.
    Stoelinga B, Huirne J, Heymans MW, Reekers JA, Ankum WM, Hehenkamp WJ. The estimated volume of the fibroid uterus: a comparison of ultrasound and bimanual examination versus volume at MRI or hysterectomy. Eur J Obstet Gynecol Reprod Biol. 2015;184:89–96. doi: 10.1016/j.ejogrb.2014.11.011. Epub 2014 Nov 20.CrossRefPubMedGoogle Scholar
  29. 29.
    Kung FT, Chang SY. The relationship between ultrasonic volume and actual weight of pathologic uterus. Gynecol Obstet Invest. 1996;42(1):35–8.CrossRefPubMedGoogle Scholar
  30. 30.
    Lee YS. Benefits of high epigastric port placement for removing the very large uterus. J Am AssocGynecol Laparosc. 2001;8(3):425–8.CrossRefGoogle Scholar
  31. 31.
    Wattiez A, Soriano D, Fiaccavento A, Canis M, Botchorishvili R, Pouly J, Mage G, Bruhat MA. Total laparoscopic hysterectomy for very enlarged uteri. J Am Assoc Gynecol Laparosc. 2002;9(2):125–30.CrossRefPubMedGoogle Scholar
  32. 32.
    Kongnyuy EJ, Wiysonge CS. Interventions to reduce haemorrhage during myomectomy for fibroids. Cochrane Database Syst Rev. 2014;8:CD005355. doi: 10.1002/14651858.CD005355.pub5.Google Scholar
  33. 33.
    Odejinmi F, Maclaran K. AgarwalN.Laparoscopic treatment of uterine fibroids: a comparison of peri-operative outcomes in laparoscopic hysterectomy and myomectomy. Arch Gynecol Obstet. 2015;291(3):579–84. doi: 10.1007/s00404-014-3434-y. Epub 2014 Sep 13.CrossRefPubMedGoogle Scholar
  34. 34.
    Matsuoka S, Kikuchi I, Kitade M, Kumakiri J, Kuroda K, Tokita S, Kuroda M, Takeda S. Strategy for laparoscopic cervical myomectomy. J Minim Invasive Gynecol. 2010;17(3):301–5. doi: 10.1016/j.jmig.2009.12.020. Epub 2010 Mar 19.CrossRefPubMedGoogle Scholar
  35. 35.
    Tariq S, Miskry TS, Kindinger LM, Setchell TE. Broad ligament fibroids—a radiological and surgical challenge. Gynecol Surg. 2014;11:19–22.CrossRefGoogle Scholar
  36. 36.
    Chandrasekaran D, Agarwal N, Oliver R, Odejinmi F. Evaluation of laparoscopic myomectomy for the management of broad ligament fibroids. Poster presentation. ESGE 2015, ES24-0515. Gynecol Surg. 2015;12(Suppl 1):S1–S494.Google Scholar
  37. 37.
    Gol M, Kizilyar A. EminogluM.Laparoscopic hysterectomy with retroperitoneal uterine artery sealing using LigaSure: Gazi hospital experience. Arch Gynecol Obstet. 2007;276(4):311–4. Epub 2007 Mar 20.CrossRefPubMedGoogle Scholar
  38. 38.
    Roman H, Zanati J, Friederich L, Resch B, Lena E, Marpeau L. Laparoscopic hysterectomy of large uteri with uterine artery coagulation at its origin. JSLS. 2008;12(1):25–9.PubMedPubMedCentralGoogle Scholar
  39. 39.
    Bohlin KS, Ankardal M, Stjerndahl JH, Lindkvist H, Milsom I. Influence of the modifiable life-style factors body mass index and smoking on the outcome of hysterectomy. Acta Obstet Gynecol Scand. 2015;95(1):65–73. doi: 10.1111/aogs.12794.CrossRefPubMedGoogle Scholar
  40. 40.
    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. doi: 10.1111/j.1471-0528.2008.01966.x. Epub 2008 Nov 11.CrossRefPubMedGoogle Scholar
  41. 41.
    Johnson N, Barlow D, Lethaby A, Tavender E, Curr L, Garry R. Methodsof hysterectomy: systematic review and meta-analysis of randomizedcontrolled trials. BMJ. 2005;330:1478.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Johnson N, Barlow D, Lethaby A, Tavender E, Curr L, Garry R. Surgicalapproach to hysterectomy for benign gynaecological disease (Review). Cochrane Database Syst Rev. 2006;3:CD003677.Google Scholar
  43. 43.
    Garry R, Fountain J, Mason S, Hawe J, Napp V, Abbott J, et al. TheeVALuate study: two parallel randomized trials, one comparinglaparoscopic with abdominal hysterectomy, the other comparinglaparoscopic with vaginal hysterectomy. BMJ. 2004;328:1229–36.CrossRefGoogle Scholar
  44. 44.
    Teeluckdharry B, Gilmour D, Flowerdew G. Urinary tract injury at benign gynecologic surgery and the tole of cystoscopy: a systematic review and meta-analysis. Obstet Gynecol. 2015;126(6):1161–9. doi: 10.1097/AOG.0000000000001096.CrossRefPubMedGoogle Scholar
  45. 45.
    Fischer J. Just Do It!: Routine Cystoscopy Should Be Done at the Time of Gynecologic Surgery. Obstet Gynecol. 2015;126(6):1136–7. - Volume Publish Ahead of Print - doi: 10.1097/AOG.0000000000001169.CrossRefPubMedGoogle Scholar
  46. 46.
    AAGL Advancing Minimally Invasive Gynecology Worldwide. AAGL position statement: route of hysterectomy to treatbenign uterine disease. J Minim Invasive Gynecol. 2011;18(1):1–3.CrossRefGoogle Scholar
  47. 47.
    U.S. Food and Drug Administration (2014) Laparoscopic uterinepowermorcellation in hysterectomy and myomectomy: FDA. Safety communication: Accessed 22 May 2014. DOI  10.1007/s10397-013-0826-0.
  48. 48.
    Arkenbout EA, van den Haak L, Driessen SR, Thurkow AL, Jansen FW. Assessing basic “physiology” of the morcellation process and tissue spread: a time-action analysis. J Minim Invasive Gynecol. 2015;22(2):255–60.CrossRefPubMedGoogle Scholar
  49. 49.
    Bojahr B, De Wilde RL, Tchartchian G. Malignancy rate of 10,731 uteri morcellated during laparoscopic supracervical hysterectomy (LSH). Arch Gynecol Obstet. 2015;292(3):665–72. doi: 10.1007/s00404-015-3696-z. Epub 2015 Mar 28.CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Parker W, Fu Y, Berek J. Uterine sarcoma in patients operated on for presumed leiomyoma and rapidly growing leiomyoma. Obstet Gynecol. 1994;84(3):414–8.Google Scholar
  51. 51.
    Odejinmi F, Agarwal N, Maclaran K, Oliver R. Should we abandon all conservative treatments for uterine fibroids? The problem with leiomyosarcomas. Womens Health (Lond). 2015;11(2):151–9. doi: 10.2217/whe.14.71.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2018

Authors and Affiliations

  1. 1.Department of Obstetrics and GynaecologyWhipps Cross University Hospital, Barts Health NHS TrustLondonUK

Personalised recommendations