LETTERS

Additional supracervical techniques offered

I read with interest Dr. Andrew Menzin’s article, “Hysterectomy: total versus supracervical surgery” [March]. It has been my practice for some time to conserve the cervix whenever possible. However, my concern has not been for the preservation of sexual function. Rather, I believe the supracervical approach is safer for the patient and—from a legal perspective—the gynecologist. The majority of lawsuits related to hysterectomy arise from alleged damage to the bladder or ureters. These risks are minimized, if not eliminated, when the cervix is conserved. Additionally, the risk of hemorrhage is greatly reduced in a supracervical procedure.

My own technique is to clamp and divide the uterine arteries after creating a small bladder flap. I then take a single pedicle from the cardinal ligaments bilaterally. Using a transverse V-shaped incision, I separate the fundus from the cervix at the level of the internal os. Finally, I easily approximate the stump edges after coagulating the endocervical canal with electrocautery.