Laparoscopic Supracervical Hysterectomy for Large Uteri
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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.
KeywordsLaparoscopic supracervical hysterectomy Surgical technique
- 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.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
- 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
- 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
- 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
- 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
- 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
- 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
- 47.U.S. Food and Drug Administration (2014) Laparoscopic uterinepowermorcellation in hysterectomy and myomectomy: FDA. Safety communication: http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm393576.htm. Accessed 22 May 2014. DOI 10.1007/s10397-013-0826-0.
- 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