Subtotal Hysterectomy

A subtotal hysterectomy removes only a woman’s uterus not her cervix. Many women may not even think about the fact that in most cases a woman loses her cervix along with her uterus. While this may not seem vastly important, losing the cervix does have consequences. Therefore, if a woman’s medical condition does not dictate the removal of the cervix, she may want to consider a subtotal hysterectomy.

The cervix is the inch or so long piece of connective tissue which forms the neck of the uterus; it is essentially the protective opening between the vagina and the uterus. Any time a woman chooses to have a vaginal hysterectomy she automatically chooses to have her cervix removed. When the cervix is removed two things may happen: One, the vaginal area may become significantly dryer; two, since the cervical tissue supports many of the pelvic ligaments, the pelvic area may become less stable. After considering these side effects, a woman may want to discuss the possibility of a subtotal hysterectomy with her doctor. A woman considering a subtotal hysterectomy needs to know that since her cervix will remain she remains vulnerable to cervical cancer. Thus, it is imperative that she have pap smears on a schedule prescribed by her gynecologist.

If a woman and her physician decide that a subtotal hysterectomy is appropriate there are generally two methods by which it may be accomplished: An abdominal hysterectomy and the tongue twisting laparoscopic supracervical hysterectomy. An abdominal hysterectomy generally requires additional time in surgery, a longer hospital stay and a longer post operative recovery period. It also leaves a large scar, although the scar can sometimes be lessened by an artful surgeon. For this reason many women consider the laparoscopic subtotal hysterectomy procedure.

A subtotal hysterectomy assisted by a laparoscope (slender optical tube) begins with a small incision below the patient’s navel through which the instrument is inserted. After the surgeon has located and examined the uterus two more small cuts will be made through which additional surgical instruments will be inserted. These tools will be used to cut the uterus, but not the cervix, away from the body. The organ will then be cut into strips small enough to be removed through the previous incisions. Scarring will be limited to the three small cuts made for inserting the needed instruments. Performed in this manner a subtotal hysterectomy requires only slightly more time in surgery than a vaginal hysterectomy. The hospital stay and recuperation time will also be somewhat longer.

A laparoscopic supracervical hysterectomy can only be used in circumstances where the uterus has not been substantially enlarged by disease. If due to an ailment the uterus has grown too large to be removed via the laparoscopic method an abdominal hysterectomy will be required. The possibility of a laparoscopic subtotal hysterectomy turning into an abdominal hysterectomy should be fully discussed with the surgeon prior to the operation.

Loss of the cervix as part of a total hysterectomy may not be of immediate concern to some women. In addition, many women may not want to have an abdominal procedure in order to retain the cervix. However, any time it is medically possible to save a piece of healthy tissue, it should be a matter for consideration. A woman who feels that she would be best served by having her cervix in place should be aware of the subtotal hysterectomy alternative.