A comparative evaluation of total laparoscopic hysterectomy and laparoscopic supracervical hysterectomy for benign uterine diseases

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.