[Re-evaluation of supra-cervical hysterectomy. Incomplete surgery or conservative surgery?]

Up to the middle of this century, most of the hysterectomies executed by benign corporal pathology were subtotal. In the last twenty years this kind of operation is becoming obsolete so that it has been considered a surgical defeat for the gynecologist, who has been judged unable on this occasion, to manage the tenacious uterine adhesions with other organs or pelvic structures. The most important objection, which was made to the supracervical hysterectomy, was that it used to leave in its site a segment of the uterus that more easily than in other cases could lead to canceration. This assertion has never been supported by an adequate cytological, colposcopic preoperatory study of the uterine cervix. Such surveys, nowadays widely spread and trustworthy, would indeed allow to suggest the total hysterectomy for patients affected by intraepithelial and/or invasive lesions. The same surveys would however suggest the conservation of the cervix to those healthy patients willing to a periodical cytological and colposcopic follow-up. Indeed the supracervical hysterectomy is undoubtedly characterized by shorter operation times; it can be easily executed by laparoscopy; it maintains a better pelvic anatomy with poor negative results on the physical, aesthetic and emotional profile.