A supracervical hysterectomy involves the surgical removal of a woman’s uterus. The procedure leaves the cervix, or lowest portion of uterus, in place. In comparison, a total laparoscopic hysterectomy removes the patient’s uterus and cervix. Medical researchers report that preserving the cervix speeds healing, minimizes pain, and helps to retain the patient’s sexual function in many cases.
Hysterectomy is a common surgical procedure. Between 20 to 33 percent of women have a hysterectomy before age 60. It’s performed for various reasons, such as fibroid benign tumors, heavy menstrual bleeding, pelvic pain, and other indications. A surgeon may perform a hysterectomy procedure in a variety of ways. Traditional hysterectomy is performed through an abdominal incision, either via a lower abdomen bikini incision or through a belly button-pubic bone incision. Hysterectomies can also be performed through a laparoscope, robotic laparoscope, or vaginal approach.
What Is a Supracervical Hysterectomy?
Supracervical hysterectomy (SH) is well tolerated by most patients. There’s less cutting internally since the cervix remains, and the average recovery time is 2-4 weeks. Traditional hysterectomy usually has more discomfort and longer recovery. Recovery from the abdominal procedure takes about six weeks. Recovery from a minimally invasive hysterectomy is similar to a supracervical hysterectomy.
An SH procedure includes the surgical removal of the patient’s uterus. The cervix is maintained to provide natural anatomical pelvic support. Ligaments, such as the uterosacral ligaments, support both the vagina and cervix.
This partial hysterectomy, unlike total laparoscopic hysterectomy, doesn’t disrupt the body’s natural support, tissue, or blood supply. For that reason, the patient may have a lower risk of developing vaginal vault prolapse, a condition in which the top part of the vagina falls down and can cause pressure and discomfort and difficulty urinating.
Keeping the cervix in place may also exactly preserve the patient’s sexual function if the woman achieves orgasm from cervical stimulation. Actually, one third of women say there orgasm and sex improved, one third stayed the same, and one third noticed no difference.
Supracervical hysterectomy doesn’t involve incisions into the patient’s vaginal canal. There’s no need to disrupt the patient’s intricate blood supply and nerves in the vaginal cavity. Another reason that healing is faster and women can resume intercourse much sooner.
Many patients in need of a hysterectomy want to decrease post-operative recovery time. Supracervical hysterectomy offers the advantage of faster post-op recovery and less downtime. In addition, the patient needs fewer post-operative pain medicines.
According to Brigham & Women’s Hospital in Boston, Massachusetts, at least 600,000 hysterectomies are performed each year. There are two primary types of supracervical hysterectomy procedures used in the United States:
- A surgeon may perform supracervical hysterectomy without a laparoscope or laparoscopic robotic instruments only if the patient has a large abdominal incision. This is because their are no incisions in the vagina. There are doctors who haven’t learned how to do a laparoscopic supracervical hysterectomy.
- In minimally-invasive or laparoscope-assisted supracervical hysterectomy, (LSH or LASH) the doctor’s skill and experience are still an essential part of the procedure. Robotic-assisted LASH procedures allow the physician to use fewer tools and perform more precision cuts during the surgical procedure.
Many more doctors have learned to perform a supracervical hysterectomy over the last decade. If the patient is unlikely to develop cervical cancer, she is typically given the option to leave the cervix in place.
Doctors and patients should discuss the pros and cons of total vs. partial hysterectomy:
- Lower disease risk. Patients with an abnormal Pap smear or certain fibroids, or severe endometriosis often want the doctor to remove the cervix to avoid future disease.
- Continue Pap smears. The patient must continue to have regular Pap smears according to doctor’s recommendations after surgery. Cervix removal doesn’t eliminate the patient’s need for regular checkups.
In procedures in which the cervix isn’t removed, researchers note an increased risk of menstrual spotting (between 5-10 percent of patients) during the time of a woman’s natural monthly cycle. However, only 2% of these patients had subsequent surgery to remove the cervix.
Who Needs a Supracervical Hysterectomy?
According to the National Institutes of Health, about 30 percent of hysterectomies are performed to address abnormal bleeding or uterine fibroids. Endometriosis, vaginal prolapse, and a pre-cancerous condition are additional reasons the women get hysterectomies in the U.S..
Women without cancer concerns are more likely to request a LASH procedure because of:
- Abnormal bleeding: Discuss LASH with your doctor when abnormal or extremely heavy vaginal bleeding and/or spotting between monthly periods occurs. Bleeding isn’t normal between monthly period cycles. Heavy flow during periods and/or spotting or bleeding between cycles should be evaluated by your doctor.
- Fibroids: Most women have fibroids, or noncancerous uterine growths, at some time during life. Fibroids most commonly appear during a woman’s childbearing years. Fibroids are also known as myomas or leiomyomas in medical literature. Fibroids are highly unlikely to become cancerous. However, larger fibroids can enlarge the patient’s uterus to the extent that it extends to the ribcage. It’s possible to have a one or many fibroid tumors but, unless they grow really large or they cause symtpoms of cramping or bleeding, no pain is associated with them. Talk to your doctor about LASH when reproductive cancer risk is low.
- Endometriosis: Recognize that women with endometriosis have more options today. Unlike the sometimes silent presence of fibroids, women with endometriosis know something is wrong. Endometriosis is often very painful, especially during a woman’s monthly menstrual cycle. In this condition, the lining of the uterus, endometrial tissue, grows outside of the uterus. Endometriosis may also involve pelvic tissue, fallopian tubes, and ovaries. Learn more about how the LASH procedure can resolve pain due to endometriosis.
Risks Involved in a Supracervical Hysterectomy
All major surgeries involve risk. Many doctors believe there are reasons to remove the cervix, even if the patient isn’t at risk for cancer. For instance:
- Leaving in the cervix may lead to pelvic pain in rare cases, caused by uterine adhesions.
- Bleeding or infection of the post-surgical cervical remnant (stump) may increase the risk of morbidity or require a subsequent procedure to excise the cervical remnant.
There are also the risks involved with any type of hysterectomy:
- Bladder injury.
- Bowel injury.
- Infection in the pelvis during the postop period
- Painful intercourse and/or low libido.
A patient’s decision to have a partial hysterectomy will be based on multiple factors. In some cases, a patient might feel strongly opposed to the loss of her cervix. According to medical guidelines, the surgeon must explain the pros and cons of available procedures. It’s ultimately the patient’s choice about whether she wants a LASH procedure.
Patients typically stay in the hospital up to the doctor will prescribe one or more medicines to take for pain at home.
Alert the doctor to the presence of a fever (above 100.4 degrees Fahrenheit), menstrual period-like bleeding (need to change a pad once per hour), pelvic or abdominal pain, discharge with a foul odor, nausea or vomiting, chest pain/difficulty breathing, development of a rash, or painful urination.
It’s normal to experience general discomfort for about two weeks after the LASH procedure. At that time, most patients say they’re enjoying regular daily activities. By six weeks, most sexually active patients feel well enough to enjoy intimate relations.
Alternatives to a Supracervical Hysterectomy
Most women should initially be offerered non-surgical therapies. These alternatives usually work very well, but somtimes the symptoms come back despite the alternatives. Additionally, some women don’t want surgery and try to wait until menopause for their symptoms to go away. However, before menopause, the doctor may prescribe:
- Tranexamic acid (TXA, Lyseda) to stabilize the uterine blood vessels and encourage coagulation of blood in the uterus (to reduce the patient’s heavy periods).
- Ibuprofen or other non-steroidal anti-inflammatory medicines to manage pain and reduce heavy bleeding by working on the uterine blood vessels.
- Ablation procedure to thin the uterine lining of women suffering from heavy menstrual bleeding. This procedure affects fertility and should only be used if the woman doesn’t want to bear children (or have more children). An ablation doesn’t last forever, usually several years, but it is very effective and done as an outpatient procedure.
- Hormonal therapy, e.g. progesterone or estrogen and progesterone (ex. contraceptive pills), usually will help to decrease heavy bleeding and minimize cramps during the menstrual cycle.
- Fibroid surgery, or myomectomy, removes fibroids in patients without removing the uterus. This can be done laparoscopically and doesn’t need to be done abdominally due to the robotic laparoscopic technology.
Generally speaking, many non hysterectomy options are available to manage endometriosis, pelvic pain, heavy bleeding, or manage fibroids.
Hysterectomy is still one of the most common surgeries for women. When a hysterectomy is necessary, SH or LASH procedures will help patients to recover more quickly and with fewer complications.
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