heading for Laparoscopic Supracervical Hysterectomy

Because hysterectomy is the second most commonly performed surgery in the U.S., some critics argue that it is performed too often and too quickly - without exploring all the available options. In my experience, women do not frivolously decide to have a hysterectomy, but come to that decision after months or even years of aggravation and pain. They may be tired of having bleeding problems because hormonal therapy failed, or other treatments to control bleeding didn't work. Others may have unsuccessfully battled fibroid tumors, often causing painful or heavy menstrual periods, pressure on the bladder, urinary frequency, a bloated feeling, and sometimes, painful sexual intercourse. Pelvic pain caused by endometriosis or scarring from prior surgeries or infections also can lead a woman to desire a hysterectomy. Whatever the reason, 650,000 hysterectomies are done each year and more than 9 in 10 women are satisfied with the choice.

Today, there are more choices than ever for women deciding to have a hysterectomy. Instead of having to endure a three day hospital stay and six week recovery for a traditional hysterectomy, many women can now choose from a few less incapacitating options. When possible, some opt for the vaginal hysterectomy, where the uterus is taken out through an incision in the vagina. This surgery usually requires a two-day hospital visit and four-week recovery - although patients must wait at least six weeks to resume sexual intercourse.

I often meet new patients who have had a procedure and tell, me with a satisfied look, that they have " only had a partial hysterectomy." What they really mean is that they underwent surgery to remove only their uterus, leaving their ovaries behind. Laparoscopic Supracervical Hysterectomy (LSH) is a procedure where only part of the uterus is removed, making it the "Partial-Partial hysterectomy." LSH has been performed for more than a decade with a remarkable safety record. It may be an excellent choice for you.

The major benefits of LSH include:

* A significantly shorter recovery time versus other procedures. Most people can return to full activity in seven to 14 days as opposed to six weeks with other surgeries.
* Increased safety - LSH is a safer procedure with less likelihood for complications from injury to surrounding organs or from postoperative infections.
* Long-term support - LSH provides better support to the top of the vagina, which may prevent prolapse.
* Maintenance (or even improvement) of sexual health, including earlier resumption of sexual activity and possibly better sexual response.

Having helped more than 60 women from across the U.S. overcome their gynecological problems through LSH, I've seen these benefits in action as my patients amaze family and friends by doing laundry, golfing, or even mowing the lawn less than a week after surgery. If you are considering a hysterectomy, LSH can make it an easier experience.

I suggest reading through the Q&A below, then looking for gynecologists who are skilled with laparoscopic procedures in general and LSH in particular. Next, "interview" the doctors you've identified by scheduling a consultation, reviewing your medical history and exploring the option of LSH. Based on the information gathered through this process as well as your comfort level with each doctor, choose the one with whom you can partner to make your hysterectomy experience as easy as possible.
Laparoscopic Supracervical Hysterectomy (LSH)
Frequently Asked Questions

Q: What is LSH?

A: Laparoscopic Supracervical Hysterectomy (LSH) is a surgery performed through small holes made in your abdomen through which the upper two thirds of the uterus are removed. The bottom third, or cervix, is left behind. (Ovaries can be also removed at the time of surgery if appropriate and if the doctor and patient agree).

Q: Why is leaving the cervix or bottom third behind so important?

A: There are several reasons this is important.

* The cervix is the key support to the upper vagina. The uterosacral ligaments literally attach the vagina to the spine via the cervix. In LSH these supports are left intact and can actually be tightened if they are loose from giving birth.
* The lower third of the uterus is near other important structures and is where most injuries occur. In LSH, you avoid that critical area.
* If the cervix is left in place it serves as a buffer, blocking bacteria from going up into the abdominal cavity. So called "vaginal cuff cellulitis" causes postoperative fever in as many as 5 percent of total hysterectomies.
* If the cervix is removed, you must limit your activity for four to six weeks to allow the top of the vagina (which will have a hole where the cervix was) to heal.
* The cervix that remains after LSH is easy to examine for routine pap smears. This can be difficult to do for patients who have undergone the so-called CISH procedure where part of the cervix is removed.
* Sexual function is less likely to be affected if the cervix is left in. Many women report that the cervix or the areas adjacent to the cervix are very sensitive and is a part of their sexual response. Scarring from and removal of the cervix may reduce their sensation. Shortening of the vagina might also be an issue if the cervix is removed.

Q: So why would anyone want to remove their cervix?

A: Originally the cervix was left behind when possible to prevent infections. After antibiotics were developed, the medical community felt it was best to remove the cervix because cervical cancer was so common. Also, in cases where a patient had a large/neglected tumor, doctors could not radiate the cervix well if the upper two thirds of the uterus was gone.

But guess what? Since that time, (the 1950s) the Pap smear was invented! As a result, cervical cancer is in fact much, much less common now. The argument that the cervix should be removed "because it might become cancerous" is, in my opinion, quite weak. Why should we remove the cervix if there are benefits to leaving it in place, and it is easy to monitor?

Q: What happens during LSH surgery?

A: Under general anesthesia, four to five small holes ¼ inch to ¾ inch are made in your abdominal wall. Then, the upper two thirds of your uterus is detached from the surrounding tissue. Next, the uterus is separated from the underlying cervix. The ovaries and fallopian tubes can be removed as well. The uterus is then morcelated, or cut into small pieces, and removed. The cut cervix is closed with sutures. This takes about one to two hours. You are awakened and brought to the recovery room where you stay under close observation for about one hour. Then, you are transferred to a regular hospital room for an overnight stay.

It has been my practice over the last five years to admit for 23 hours observation. (I am aware that in other programs and in other cities, patients are released that day after they are up, walking, and eating. I have released patients same day if they so desire.) Patients may return to full activity within 5 to 14 days. Most feel back to normal after a week.

Q: Am I a candidate for LSH?

A:

* You are not if you have ever been found to have dysplasia or precancerous cells on your Pap smear.
* You must have had a documented normal Pap smear within the last few months.
* You cannot have a large amount of scarring or adhesions caused by prior surgeries or infections. A ruptured appendix or other extensive abdominal surgery may cause this.
* You should be a reliable patient, i.e. willing to come in for annual visits and Pap smears.

Q: It sounds almost too good to be true. What do patients not like about LSH?

A: The one complaint specific to this surgery is that approximately 5 percent of the patients will have a day or so of light spotting. This occurs only with patients who have functioning ovaries that are not removed. The few patients of mine who have these "mini-periods" don't seem to mind them.
For more information about LSH, contact Dr. Simckes at 314-997-7177 or at This e-mail address is being protected from spambots. You need JavaScript enabled to view it

©2006 D. Elan Simckes, MD