Minimally Invasive Total Versus Supracervical Hysterectomy With Sacrocolpopexy

Limited data exist comparing total laparoscopic hysterectomy (TLH) versus laparoscopic supracervical hysterectomy (LSCH) at the time of minimally invasive sacrocolpopexy for uterovaginal prolapse.

The objective of this study was to compare TLH versus LSCH at the time of minimally invasive sacrocolpopexy for uterovaginal prolapse, hypothesizing that LSCH would demonstrate a higher proportion of recurrent prolapse, but a lower proportion of mesh exposures.

This was a retrospective, secondary analysis comparing a prospective cohort of patients undergoing TLH sacrocolpopexy versus a retrospective cohort of patients who had undergone LSCH sacrocolpopexy. Our primary outcome was composite anatomic pelvic organ prolapse recurrence (prolapse beyond hymen, apical descent > half vaginal length, retreatment). Secondary outcomes included vaginal mesh exposures.

There were 733 procedures: 184 (25.1%) TLH sacrocolpopexy and 549 (74.9%) LSCH sacrocolpopexy. Median follow-up was longer in the TLH cohort (369 [IQR 354-386] vs 190 [IQR 63-362] days, P < 0.01). There was no difference in composite prolapse recurrence between groups on bivariable analysis (3.3% vs 4.7%, P = 0.40). However, multivariable logistic regression demonstrated that TLH sacrocolpopexy had lower odds of composite pelvic organ prolapse recurrence than LSCH sacrocolpopexy (OR 0.21, 95% CI 0.05-0.82, P = 0.02). Among procedures with lightweight mesh types, TLH demonstrated a higher proportion of mesh exposures compared to LSCH (10 [5.4%] vs 4 [1.1%], P < 0.01); however, this was not significant after controlling for confounders (OR 4.51, 95% CI 0.88-39.25, P = 0.08). There were no differences in retreatment or reoperation.

For the treatment of uterovaginal prolapse, both TLH and LSCH are acceptable methods of concomitant hysterectomy at the time of minimally invasive sacrocolpopexy, albeit with likely different risk profiles.