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Laparoscopic Supracervical Hysterectomy (LSH)

Laparoscopic and Minimally Invasive Procedures

Laparoscopic Supracervical Hysterectomy (LSH) is a type of hysterectomy that allows the woman to retain her cervix while taking out the part of the uterus that causes the painful periods and heavy vaginal bleeding. Some women feel that their cervix helps to maintain their sexual function and provides pelvic organ support. Our doctors can accommodate this request by performing an Laparoscopic Supracervical Hysterectomy (LSH) in certain patients. A recent New England Journal of Medicine article found that patients undergoing an Laparoscopic Supracervical Hysterectomy (LSH) had shorter operating times, shorter hospital stays and fewer complications than if they were to undergo an Laparoscopic Assisted Vaginal Hysterectomy (LAVH). In addition, there has been no published data to confirm that the cervix helps to maintain pelvic organ support. With our advanced laparoscopic skills, we can perform the Laparoscopic Supracervical Hysterectomy (LSH) with other reconstructive procedures if needed and our patients usually go home the next day. However many other studies have also shown NO difference in sexual function between groups of women undergoing hysterectomy  with removal of their cervix compared to women without removal of the cervix. Dr Miklos and Moore will review the data with you in regards to the cervix and sexual function as well as pelvic organ support  and help you make an educated decision about whether or not to remove the cervix at time of hysterectomy.

Indications

The indications for an Laparoscopic Supracervical Hysterectomy (LSH) are the same as for those undergoing an Laparoscopic Assisted Vaginal Hysterectomy (LAVH) with the patient's desire to retain the cervix. If there are signs and symptoms of pelvic organ prolapse or urinary incontinence, Drs. Miklos and Moore can incorporate their array of laparoscopic techniques to correct these problems at the time of the Laparoscopic Supracervical Hysterectomy (LSH).

Laparoscopic Supracervical Hysterectomy (LSH) Indications

• Desire to Retain Cervix
• Pelvic Prolapse
• Urinary Incontinence
• Fibroids
• Endometriosis
• Pelvic Pain/Adhesions
• Ovarian Cysts
• Heavy Vaginal Bleeding (Periods)

Contraindications

The contraindications to the Laparoscopic Supracervical Hysterectomy (LSH) are the same as the Laparoscopic Assisted Vaginal Hysterectomy (LAVH). As stated earlier, they would be if the uterus is greater than 20-22-week size or if you have a serious medical condition that would not be safe to undergo anesthesia. Additionally, women with a history of abnormal PAP smears, enlarged cervix, pain with intercourse or pain on palpation of the cervix should strongly consider removal of cervix at time of hysterectomy.

Complications

Laparoscopic Supracervical Hysterectomy (LSH) has its unique complications in addition to the previously mentioned in the LAVH section because the cervix remains behind. Although we have not had complications, a study by van der Stege had 25% of the patients continued to menstruate and 10% had vaginal discharge. By the fact that the cervix is attached to the vagina, some vaginal length may be compromised during a hysterectomy. We attempt to minimize removing the vaginal tissue, but if the cervix was to remain, then there would be no additional tissue removed and vaginal length maintainged. If there is no prolapse present prior to surgery (ie in a patient that is having a hysterectomy due to fibroids alone), then it does make sense to leave the cervix in place…the pathology is being removed with the uterus itself, the length of the vagina is maintained, it is less invasive and the pelvic organ support (ie the uterosacral ligaments that attach to the pericervical ring on the cervix ) are not cut and are maintained. However in a patient with prolapse, the support is already compromised and there may be enteroceles (hernias) between the cervix and lower vagina and therefore in many cases it does not make sense to try to save the cervix as it is harder to reconstruct the top of the vagina with the cervix in the way. Others will claim that leaving the cervix in place at time of mesh sacralcolpopexy to support the top of vagina and cervix helps protect again mesh extrusions through the top of the vagina and therefore the cervix should be left in place. Again, Dr Moore and Miklos will review these options in great detail with you at your initial visit.

Laparoscopic Supracervical Hysterectomy LSH Complications

• Vaginal Discharge
• Cerivcal Discharge
• Bladder Injury
• Ureter Injury
• Nerve Injury
• Intestinal Injury

Atlanta Urogynecology Associates Experience

Drs. Miklos and Moore have been performing the Laparoscopic Supracervical Hysterectomy (LSH) by the request of their patients. Because of our vast experience in laparoscopic surgery, we can perform this technically difficult procedure in an efficient manner and are able to addr.ess any concurring problems at the time of Laparoscopic Supracervical Hysterectomy (LSH). All of the benefits of the Laparoscopic Assisted Vaginal Hysterectomy (LAVH) apply in addition to even a shorter operating time when the cervix remains intact.

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