EXPORT CITATION

Chapter-23 Laparoscopic Supracervical Hysterectomy

BOOK TITLE: State of the Art Atlas of Endoscopic Surgery in Infertility and Gynecology

Author
1. Lyons Thomas L
ISBN
9788184489903
DOI
10.5005/jp/books/11190_23
Edition
2/e
Publishing Year
2010
Pages
10
Author Affiliations
1. 1140 Hammond Drive, Suite F6230 Atlanta, Georgia 30328, Atlanta, Georgia, USA
Chapter keywords

Abstract

All surgical procedures currently in widespread use have been subjected to thorough clinical evaluation and have met the basic criterion required by ethical physicians for continued usage. Hysterectomy as stated by Finley in 1943 must be used to: (i) Save life, (ii) Correct deformity, or (iii) Eliminate suffering. In the late 1980s, a revolution was about in the US with laparoscopic cholecystectomy being introduced, rapid technological development and surgeons grasping the concept of the lowered morbidity of minimally invasive surgery. Although, gynecologists were the leaders in this revolution, the movement into more advanced procedures by the generalist OB/Gyn seemed to be mired. Reich first reported laparoscopically-assisted vaginal hysterectomy (LAVH) in 1989 and the push began. Over the next ten years, we performed approximately 750 procedures with continued low morbidity while treating uteri up to 2400 grams, stage IV endometriosis, severe PID, ovarian cancer, leiomyosarcoma and total pelvic floor prolapse. These patients continued to have a remarkable recovery with lower than normal morbidity despite the increased complexity of the procedures. Of course, the learning curve played a role in these statistics, but the clinical results were sufficient to warrant the continuation of the LSH procedure. There are many studies that have demonstrated the efficacy of laparoscopic supracervical hysterectomy and its superiority over total laparoscopic hysterectomy, laparoscopic assisted vaginal hysterectomy. Total abdominal hysterectomy. The following studies by Lyons, Mowafi, Donnez, Nisolle, Sarmini, Huffman, Mettler, Semm, Milad, Lalonde and Danielle have all demonstrated that LSH scores over in many respects like efficacy, versatility, safety, reliability and cost effectiveness: It has been documented by studies of Gary et al in a analysis that laparoscopic hysterectomy is superior in morbidity and mortality. Evaluate study showed that laparoscopic approach was better to identify pathology compared to vaginal or abdominal approach. Total laparoscopic hysterectomy is a good procedure but it more difficult to perform. Supracervical hysterectomy scores over in particularly dealing with difficult sacrocolpopexy procedures done for pelvic floor defects. It has low morbidity when vault is not opened and pericervical ring is maintained. Authors, as well as, Mowafi et al also opined better sexual function after supracervical hysterectomy, immediately as well as in long follow-up. Author demonstrates the benefit of the laparoscopic supracervical approach to hysterectomy for large uterus. The Clermont Ferrand group reported similar success with large uteri with total laparoscopic hysterectomy. So, laparoscopic supracervical hysterectomy and other laparoscopic approaches to hysterectomy are viable alternatives to total abdominal hysterectomy and total vaginal hysterectomy for large uterine myoma.

Related Books

© 2019 Jaypee Brothers Medical Publishers (P) LTD.   |   All Rights Reserved