Page 32 - World Journal of Laparoscopic Surgery

ORIGINAL ARTICLE
A Comparative Evaluation of Total Laparoscopic

Hysterectomy and Laparoscopic Supracervical Hysterectomy

for Benign Uterine Diseases

2
1
Kavita Khoiwal , Pradeep Garg , Alka Kriplani 3
AbstrAct
Background: Laparoscopic supracervical hysterectomy (LSH) is a minimally invasive alternative to total laparoscopic hysterectomy (TLH), which
is a common procedure in developed countries. The study aimed to evaluate the safety (risks vs benefits) of LSH in the Indian scenario when
compared with TLH in terms of intraoperative and postoperative outcome measures. Furthermore, quality of life (bladder, bowel, and sexual
functions) was also evaluated.
Materials and methods: A prospective randomized study among 30 patients with benign uterine pathology for hysterectomy was included
in the study. Patients were divided randomly into LSH (n = 15) and TLH (n = 15) groups. Intraoperative outcome measures, such as operation
time, blood loss, and visceral injuries were noted. Postoperative outcome measures included absolute change in hemoglobin (Hb), duration of
hospital stay, pain, urinary complaints (retention, dysuria), and bladder, bowel and sexual functions for 6 months.
Results: Demographic data were comparable in both groups. The operating time and blood loss were more in LSH than TLH group, (p = 0.29
and 0.37). The absolute change in hemoglobin was more in LSH group than TLH group (p = 0.001). Postoperative pain was indifferent in both
the groups on postoperative day 0 and day 7 but it was significantly less in LSH group on day 1 (p = 0.03). Duration of hospital stay was similar
in both groups. No patient required readmission. Patients in TLH group took a lesser number of days to return to routine activity compared to
LSH group. The postoperative bladder, bowel, and sexual functions were comparable. The incidence of post-LSH vaginal bleeding was 13.3%.
No vault prolapse was noted at the end of 6 months follow-up.
Conclusion: Laparoscopic supracervical hysterectomy is safe and efficacious as TLH for benign uterine pathologies but has no extra benefits
rather is associated with a persistent risk of developing cervical diseases and malignancy.
Keywords: Abnormal uterine bleeding, Fibroid uterus, Laparoscopic supracervical hysterectomy, Total laparoscopic hysterectomy.
World Journal of Laparoscopic Surgery (2021): 10.5005/jp-journals-10033-1442

bAckground
1 Department of Obstetrics and Gynaecology, All India Institute of
Hysterectomy is a common gynecological surgery. The prevalence Medical Sciences, Rishikesh, Uttarakhand, India
1
of hysterectomy in India ranges from 1.7 to 7.8%. Vaginal route is 2,3 Department of Obstetrics and Gynaecology, All India Institute of
always preferred as it obviates the need for abdominal incision Medical Sciences, New Delhi, India
but in cases where the vaginal route is not feasible laparoscopic Corresponding Author: Kavita Khoiwal, Department of Obstetrics and
2
hysterectomy is better than abdominal hysterectomy. Laparoscopic Gynaecology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand,
hysterectomy is now being performed globally, primarily because India, Phone: +91 9690396908, e-mail: kavita.kh27@gmail.com
of lower morbidity and faster recovery time. How to cite this article: Khoiwal K, Garg P, Kriplani A. A Comparative
The laparoscopic supracervical hysterectomy (LSH) provides Evaluation of Total Laparoscopic Hysterectomy and Laparoscopic
yet another minimally invasive approach in which the body of the Supracervical Hysterectomy for Benign Uterine Diseases. World J Lap
uterus is removed while the cervix is preserved. LSH is less invasive Surg 2021;14(1):30–33.
compared to other approaches of hysterectomy and has also been Source of support: Nil
referred to as pain-less hysterectomy. The LSH procedure does not Conflict of interest: None
require the woman to lose her cervix which seems to be a major Ethical approval: The study has been approved by institutional ethical
concern for many women who need to have a hysterectomy. With board. Research involved human participants. Informed consent was
the development of screening techniques and minimally invasive taken from all the participants.
methods to treat cervical intraepithelial lesions, the removal
of the cervix at the time of hysterectomy in low-risk patients is
more of a preference than a requirement. The advantages of LSH
include minimal invasion, improved sexual function, fewer urinary be recommended for benign uterine pathologies with no history
complications, and preservation of the cervix with its ligamentous of cervical dysplasia. 3
4
supports. Simultaneously, LSH is associated with persistent risk Cooper et al. found LSH more effective than endometrial
of cervical disease, persistent vaginal bleeding, pelvic pain, and ablation without increasing the risk of complications and proposed
complications with future surgery if required. Therefore, LSH should LSH as a potential mode of hysterectomy. Other studies suggested

© Jaypee Brothers Medical Publishers. 2021 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License
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