Supracervical hysterectomy: ... a time for reappraisal

Supracervical or subtotal hysterectomy is a procedure that largely was discarded in the middle part of this century. This decision was made because of the reduction in morbidity and mortality associated with total hysterectomy, the only known and available method for the prevention of cervical cancer. This rationale, appropriate earlier in the century, has become somewhat undermined with the advent of Papanicolaou smear screening, colposcopic diagnosis, and simple outpatient therapy for preinvasive cervical neoplasia. Furthermore, some have argued that supracervical hysterectomy better preserves bladder and sexual function, and may be associated with reduced surgical and postoperative morbidity. Recently, laparoscopic supracervical hysterectomy has been introduced as another operative alternative with putative advantages over the procedure performed via laparotomy. However, for routine cases, the available literature does not confirm that one procedure is superior, regardless of the route of access. In selected cases, where benign conditions significantly distort the cervical anatomy complicating the dissection, supracervical hysterectomy would seem a prudent choice. It is clear that appropriately designed comparative studies are in order, to better determine the place for supracervical hysterectomy in the contemporary management of women with benign uterine disease.