Laparoscopic Supracervical Hysterectomy

Supracervical hysterectomy refers to leaving the cervix behind and removing the upper portion of the uterus. The cervix is transected at the isthmus, the narrow portion at the neck of the uterus, and the uterus is then removed through a larger incision in the abdominal wall through either a morcellator – an electrically powered device with a circular blade that cores out the uterus – or through a larger incision for very large uteri.

Contrary to what may be read online, either from OB/GYN websites or other sources, supracervical hysterectomy in NOT better than removal of the cervix with the uterus. In fact, multiple studies over the past 5 to 10 years have clearly shown that there is no advantage to leaving the cervix in place. Commonly discussed advantages to leaving the cervix, such as preservation of sexual function, normal intercourse, preservation of vaginal length and width, elimination of prolapse or "drop down" of the vagina, increased lubrication, and others are not shown in the medical literature. There is, therefore, no medical advantage to leaving the cervix in place.

There are disadvantages, however, including the need for annual pap smears, possible precancerous conditions of the cervix and cervical cancer, spotting and bleeding from the glands of the cervical canal, and pain with intercourse due to adhesions between bowel, ovaries, bladder, rectum and the cervical "stump" that remains after the surgery. Also, removal of the top of the uterus through the abdominal wall, NOT the vagina, will require the use of a larger 15 mm incision with an expensive morcellator. This increases operating room time, pain due to the larger incision, an increased risk of bleeding and herniation at the incision site, all leading to increased recovery time when compared to the two port ALS hysterectomy.

WSC physicians can perform all types of procedures. Supracervical hysterectomy is easily performed, and is actually a simpler operation than hysterectomy with cervical removal. Why then don’t the physicians at WSC advocate supracervical procedures? The reason is that there is no indication to perform these operations that would lead to a benefit to the patient. Understand that marketing plays a bigger role than ever in health care, and with patients understanding the benefits of laparoscopic surgery over open procedures, they are demanding that their physicians offer them this option. OB/GYN surgeons have limited or no exposure to advanced laparoscopic techniques, and perform limited numbers of standard or robotic hysterectomies. The OB/GYN will potentially increase their rates of injury to the bowel, bladder, and ureters if they attempt to remove the cervix in all patients. As a result, supracervical procedures are advocated by many OB/GYN’s trying to provide their patients with laparoscopic surgery. The supracervical hysterectomy can be accomplished by the average OB/GYN surgeon simpler and faster, and becomes the method of choice. To support this position, many OB/GYN surgeons market the supracervical approach as a "better" alternative to removal of the cervix. This is simply not true, and the adoption of supracervical procedures by OB/GYN's is a marketing technique to capture patients for laparoscopic surgery.

Note that the American College of OB/GYN recently came out with a statement that too many supracervical procedures are being performed, mainly for the reasons noted above. If supracervical hysterectomy is offered to you as a form of treatment, ensure that you discuss with your surgeon the reasons for choosing this type of procedure over removal of the cervix and uterus.

Comparison Chart

Laparoscopic Supracervical Hysterectomy vs Laparoscopic Hysterectomy vs Open