|September 2004 · Vol. 16, No. 9
UPDATE ON TECHNOLOGY
New Developments That are Changing Patient Care
Subtotal vs total hysterectomy:
Does the evidence support saving the cervix?
Research does not support claims that preservation of the cervix reduces sexual dysfunction, incontinence, or surgical complications.
Dr. Levy is medical director, Women’s Health Center, Franciscan Health System, Federal Way, Wash. She also serves on the OBG Management Board of Editors.
Sexual function is not improved more with supracervical than with total hysterectomy.
Operative morbidity for supracervical and total hysterectomy are similar.
Pelvic-floor support and urinary incontinence do not seem to be improved with the supracervical approach.
Cyclic bleeding occurs in 5% to 20% of women after supracervical hysterectomy.
Reoperation rates for symptoms related to the retained cervix are significant—over 20% in the hands of highly skilled surgeons.
“There is something fascinating about science. One gets such wholesale returns of conjecture out of such a trifling investment of fact.”
Mark Twain, Life on the Mississippi
Thanks to the advent of minimally invasive, organ-preserving treatments such as endometrial ablation, progesterone-containing intrauterine delivery systems, and uterine fibroid embolization, today’s patients suffer less morbidity and enjoy better outcomes for a number of procedures. To take advantage of the potential for improved patient care, we try to use every new technology for every suitable candidate.
Hysterectomy is an obvious target. The number of hysterectomies performed has not declined substantially since these technologies were introduced, and persists at more than 550,000 per year in the United States. It is still the most widely performed major gynecological procedure.