There should be no reason why a woman with a normal cervix, who has had normal smears should have her cervix removed, especially if she is having a hysterectomy for fibroids or for heavy periods.
The arguments for and against having a laparoscopic subtotal hysterectomy are:
- Shorter recovery time: recovery from the procedure takes about 1-2 weeks with a full return to function for most women within 2-4 weeks
- Better sex: the jury is still out on this, but what is known is that
- Women who have subtotal hysterectomy resume sex earlier than women who have had a total hysterectomy.
- Some believe that from some women orgasm originates from the cervix. If this is the case then if the cervix is left behind then the source of orgasm is not removed.
- The vagina is not entered when a subtotal hysterectomy is performed therefore the vagina is not shortened therefore theoretically sex life should not change
This is because the ”pericervical ring” tissue around the cervix that helps support the vagina is not interrupted
during the procedure. Scientific studies however have not been done to support or refute this.
4. Bladder of bowel function: there is no difference in bowel or bladder function
5. Decrease in complication rates:
the major injury that is reduced is injury to the ureters. Because the operation is above the ureters they are
protected.
6. Easier operation for the surgeon
Those that argue against leaving the cervix behind argue that it may be the source of future cancer. The risk of developing cervical cancer on the cervical stump after 3 negative smears is less than 0.4%. This risk is much less than developing cancer of the vagina after total hysterectomy but no one removes the vagina because of future risk of that cancer.
As with all things the risks need to be balanced against the benefits.
In summary LASH is the ideal hysterectomy for heavy menstrual bleeding it is ideal because:
- Hospital stay can be only 24 hours in fact it can be done as a day case procedure
- It produces minimal scaring - Minimally invasive
- It is the most cosmetic - no large abdominal incision
- Causes the least stress to your body
- There is no scar in vagina
- There is no shortening of the vagina
- Fewer complications
- It provides more satisfactory sex life after surgery