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Minimally Invasive Total Versus Supracervical Hysterectomy With Sacrocolpopexy.
Lauren E Giugale, Kristine M Ruppert1, Sruthi L Muluk2
1University of Pittsburgh, Pittsburgh, PA.
Urogynecology (Philadelphia, Pa.)
|January 3, 2025
Summary
Total laparoscopic hysterectomy (TLH) and laparoscopic supracervical hysterectomy (LSCH) are viable options for uterovaginal prolapse treatment during sacrocolpopexy. TLH showed lower recurrence rates, while both methods have distinct risk profiles.
Area of Science:
- Urogynecology and Pelvic Reconstructive Surgery
- Minimally Invasive Gynecologic Surgery
- Pelvic Organ Prolapse Management
Background:
- Uterovaginal prolapse is a common condition affecting women's quality of life.
- Minimally invasive sacrocolpopexy is a standard surgical approach for pelvic organ prolapse.
- The choice of concomitant hysterectomy (total laparoscopic hysterectomy vs. laparoscopic supracervical hysterectomy) during sacrocolpopexy lacks comparative data.
Purpose of the Study:
- To compare total laparoscopic hysterectomy (TLH) versus laparoscopic supracervical hysterectomy (LSCH) when performed concurrently with minimally invasive sacrocolpopexy for uterovaginal prolapse.
- To evaluate the hypothesis that LSCH would be associated with higher prolapse recurrence but lower mesh exposure rates compared to TLH.
Main Methods:
- Retrospective secondary analysis comparing prospective (TLH) and retrospective (LSCH) cohorts.
- Primary outcome: Composite anatomic pelvic organ prolapse recurrence (defined by prolapse beyond hymen, apical descent, or retreatment).
- Secondary outcome: Vaginal mesh exposures.
Main Results:
- 733 procedures were analyzed: 184 (25.1%) TLH sacrocolpopexy and 549 (74.9%) LSCH sacrocolpopexy.
- Multivariable analysis revealed TLH sacrocolpopexy had significantly lower odds of composite pelvic organ prolapse recurrence (OR 0.21, P=0.02).
- No significant difference in mesh exposures was found after controlling for confounders (OR 4.51, P=0.08), despite a higher rate in TLH with lightweight mesh (5.4% vs 1.1%).
Conclusions:
- Both TLH and LSCH are acceptable surgical options for hysterectomy during minimally invasive sacrocolpopexy for uterovaginal prolapse.
- The procedures appear to have different risk profiles regarding prolapse recurrence.
- Further research may be warranted to fully elucidate the comparative risks and benefits.
