Cervical conservation: the future of hysterectomy?

Abstract

Objective There has been much debate about the place of subtotal hysterectomy in gynaecological practice. With the more widespread introduction of the laparoscopic approach to cervical conservation, this issue has once again been brought into prime focus. We have reviewed the currently available literature in an attempt to present a balanced summary of the evidence encompassing both laparoscopic and conventional subtotal hysterectomy. Method Papers were identified using Current Contents (clinical medicine) and the Index Medicus (Medline). Various outcomes were examined, in particular cervical stump carcinoma, sexual function, urinary function, psychic health and operative complications. Conclusion The risk of carcinoma of the stump is very low and techniques to remove the transformation zone may all but eliminate this risk. There appears not to be any long‐term statistically significant difference between total and subtotal hysterectomy with respect to sexual function, urinary function or psychic health. Comparisons between different operative techniques are lacking; however operative complications involving the urinary tract and postoperative sepsis are less common with cervical conservation. With improvements in laparoscopic technique, this modality of surgery appears to be as safe as conventional surgery with particular benefits evident for the supracervical approach.