A hysterectomy is removal of the uterus, and there are several methods for doing this, including incisions near the pelvis that are large and simply allow access to take the entire uterus out. One of the things patients can opt for under certain circumstances is supracervical or partial hysterectomy, where the uterus is removed but the cervix remains. This used to be the most common method or uterine removal, but was generally achieved by large incision. Now, with laparoscopy (tiny incisions in the stomach and the use of a device called a laparoscope), it is often possible to perform a hysterectomy without a large incision. Instead, when doctors perform laparoscopic supracervical hysterectomy (LSH), they perform a partial hysterectomy through a laparoscopic method.
Laparoscopic supracervical hysterectomy is by no means always the preferred procedure. It is most often used to treat unusual uterine bleeding, for fibroids, and sometimes for endometriosis. It is usually not indicated when there is uterine cancer present since this may risk cervical cancer, and a partial hysterectomy of any kind can’t be done if cervical cancer is present. If the uterus is very large, it may also be important to perform a different type of surgery for removal, and the same may hold true if fibroids are extremely large.
One of the choices in laparoscopic supracervical hysterectomy is whether the doctor should also remove the ovaries. The method will support ovary removal, but many women, provided the ovaries are healthy, opt to retain them. Removal means that a woman will begin menopause because she will no longer produce estrogen. The issue to retain the ovaries in place is related to the issue of whether the cervix should be removed. Many doctors feel that retaining the cervix makes fewer changes in a woman’s body. She may have fewer changes in bladder or bowel function, and the cervix has a role in providing some sexual pleasure.
It’s often claimed that leaving the cervix intact helps to keep a woman’s ability to feel sexual pleasure at the same level. The cervix does produce mucus, and when removed, some women may suffer vaginal dryness. Studies on this issue, however, don’t necessarily bear out that sexual pleasure remains constant post-partial hysterectomy. Some women who have had a laparoscopic supracervical hysterectomy do experience changes, and not for the better, in sexual experience afterwards.
There are some clear advantages to laparoscopic supracervical hysterectomy. These include shortened recovery time. Most women spend no more than a day in the hospital and the procedure may be outpatient. People who have this procedure may be able to return to normal activities in about a week. There’s also lower risk, potentially, of damaging structures in the vagina, since no vaginal incisions are required.
The procedure is an interesting one and many gynecologists are excellent at performing it. It is not right for every woman, and even when a laparoscopic supracervical hysterectomy is planned, sometimes doctors must switch to another procedure during surgery. Women who must undergo any form of hysterectomy should discuss with their doctors the risks, benefits and appropriateness of each method, and can certainly ask doctors if LSH might be a viable hysterectomy method.
