Minimally invasive surgery - Laparoscopic hysterectomy

 

Laparoscopic supracervical hysterectomy (LSH)

Laparoscopic supracervical hysterectomy is a form laparoscopic hysterectomy in which the cervix is not removed. The entire procedure is performed through small incisions in the abdomen similar to other types of laparoscopy. However, no vaginal surgery whatsoever is required. The uterus is separated from all its attachments, and finally, the upper part of the uterus is separated from the cervix. The upper uterus is then removed from the abdomen in small pieces, a technique called "morcellation." Because the cervix is left in place, you must continue annual pap smears to screen for cervical cancer.

 

So why leave the cervix? Cervical preservation with the LSH procedure leads to less vaginal dryness because the glands of the cervix secrete mucous. Sexual activity is often less painful due to superior lubrication. LSH also affords better pelvic support, because the ligaments that support the cervix and vagina are left intact. Finally, LSH leads to quicker recovery compared to traditional laparoscopic hysterectomies with removal of the cervix, because the steps necessary to remove the cervix can cause significant postoperative pain.

 

Many physicians believe that the potential disadvantage of preserving the cervix outweigh the advantages. However, our patients have the opportunity to chose the procedure that suits their lifestyle, concerns for their future health, and need for rapid recovery. Of course, patients wishing to retain the cervix at the time of hysterectomy must be free of any diseases of the cervix, and should certainly have a long history of normal Pap smears.

 

Classical intrafascial supracervical hysterectomy (CISH procedure)

The CISH procedure, first described by a German gynecologist in the early 1990s, is a refinement on the laparoscopic supracervical hysterectomy.

 

The argument often used to criticize the LSH resulted from concern over leaving the cervix after the upper part of the uterus was removed. Up to 25% of women who have undergone an LSH have been reported to have light menstrual bleeding thereafter. This might seem impossible, but uterine lining tissue (endometrium) is often found to exist microscopically within the canal of the cervix. Should a patient with this condition undergo an LSH, there is no reason that this tiny amount of endometrium wouldn't continue to bleed monthly, even after the majority of the uterus had been removed.

 

The CISH procedure therefore removes the cervical canal, thereby preventing any postoperative menstrual bleeding. The cervix is then simply sealed with suture material, but not until the upper uterus itself has been removed through this newly created canal.

 

Women who feel strongly that they do no want to risk the potential loss of support to the upper vagina by removing the cervix would find this excellent modification a welcome improvement on the LSH.

 

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