Laparoscopic Supracervical Hysterectomy Performed With and Without Excision of the Endocervix: A Randomized Controlled Trial

Study Objective: To compare the occurrence of vaginal bleeding and patient satisfaction 12 months after laparoscopic supracervical hysterectomy performed with and without excision of the endocervix. Design: A prospective, randomized, controlled trial. Design Classification: Canadian Task Force Classification I. Setting: Norwegian university teaching hospital. Patients: One hundred forty consecutive premenopausal women referred for hysterectomy on the basis of a benign condition. Interventions: The study participants were randomized to standard laparoscopic supracervical hysterectomy (n = 70) or laparoscopic supracervical hysterectomy with excision of the endocervix in a reverse cone pattern (n = 70). Measurements and Main Results: The main outcome measures were the occurrence of vaginal bleeding and patient satisfaction 12 months after the procedure. One hundred thirty women (92.3%) were followed up according to the study protocol. In total, 43 women (33.1%) reported bleeding episodes during the first 12 months after the laparoscopic supracervical hysterectomy; 22(16.9 %) of these women had cyclic bleeding. All reported bleeding episodes were minimal. Patient satisfaction after the hysterectomy was very high with a mean visual analog score (on a scale of 0-10) of 9.3 (standard deviation = 1.4). There were no significant differences between the 2 treatment groups regarding the main outcomes 12 months after the procedure. Conclusion: The patient satisfaction after laparoscopic supracervical hysterectomy is very high. Episodes of minimal vaginal bleeding after the procedure are relatively common, but such bleeding does not affect patient satisfaction. Removal of the endocervix by reverse conization during laparoscopic supracervical hysterectomy appears to have no effect in terms of reduced bleeding or improved patient satisfaction. Journal of Minimally Invasive Gynecology (2013) 20, 368-375 (C) 2013 AAGL. All rights reserved.