AAGL practice report: practice guidelines for laparoscopic subtotal/supracervical hysterectomy (LSH)

The first subtotal abdominal hysterectomy was described by Charles Clay in 1843, and the first laparoscopic subtotal hysterectomy (LSH) was described by Semm [1] in 1991. Whether to retain or remove the cervix remains controversial, with surgeons citing sexual satisfaction and prevention of pelvic organ prolapse as indicators for retention [2]. Because the only absolute indication for cervical removal is malignancy or its precursors, debate has continued as to the optimum surgical approach to hysterectomy for other indications. The evidence obtained from evaluating the effects of retaining the cervix, via any surgical approach, on sexual, urinary, and bowel function remains controversial [3-11]. The literature evaluating LSH is limited, and only 3 randomized controlled trials (RCTs), including 342 women, have reported psychologic outcomes, complications, and additional cervical procedures [4,12,13]. For the abdominal equivalent, there are 9 RCTs, including 1553 women, and a Cochrane review reported few important differences between the 2 approaches [8]. No such comparative data are available for LSH. This practice guideline will evaluate the evidence for LSH. This report was developed under the direction of the Practice Committee of the AAGL as a service to their members and other practicing clinicians.