A hysterectomy, the surgical removal of the uterus, is one of the most common gynecological procedures performed worldwide. Traditionally, it was carried out through open abdominal or vaginal approaches, but with advances in minimally invasive techniques, laparoscopic hysterectomy has become a safer, faster, and more patient-friendly alternative. Among its various forms, the Laparoscopic Supracervical Hysterectomy (LSH) stands out as a technique that removes the body of the uterus while preserving the cervix. This approach balances symptom relief with potential benefits of cervix retention, such as pelvic floor support and sexual function preservation.

What is Laparoscopic Supracervical Hysterectomy?

In LSH, the uterine corpus (body) is removed, but the cervix is left in place. The fallopian tubes and ovaries may or may not be removed, depending on the patient’s condition and surgical plan. The laparoscopic approach allows surgeons to perform the procedure through small abdominal incisions using specialized instruments and a camera, offering patients a minimally invasive solution with quicker recovery compared to open hysterectomy.

Indications for LSH

LSH is typically chosen in women who require uterine removal but who do not have disease affecting the cervix. Indications include:

Symptomatic fibroids causing heavy bleeding, pain, or pressure symptoms.

Adenomyosis or abnormal uterine bleeding unresponsive to medical therapy.

Endometriosis with uterine involvement.

Benign uterine enlargement interfering with quality of life.

Desire for hysterectomy with cervix preservation for sexual or anatomical reasons.

It is not recommended in women with cervical dysplasia, cervical cancer, or those at high risk of cervical pathology.

Surgical Technique

Dr. R. K. Mishra and other laparoscopic experts highlight that the success of LSH lies in precise dissection and safe execution. The procedure generally follows these steps:

Patient Preparation and Positioning

The patient is placed under general anesthesia in lithotomy position with Trendelenburg tilt.

A uterine manipulator is introduced to aid mobilization.

Creation of Pneumoperitoneum

CO₂ gas is insufflated using a Veress needle or open technique.

Trocars are placed strategically to allow laparoscope and instrument access.

Assessment of Pelvis

The uterus, ovaries, fallopian tubes, and surrounding structures are inspected.

Dissection and Control of Uterine Vessels

The uterine vessels are coagulated and transected laparoscopically.

Amputation of the Uterus

The body of the uterus is detached from the cervix using monopolar or bipolar energy devices.

The cervix is left intact, and hemostasis of the cervical stump is ensured.

Tissue Extraction

The excised uterine tissue is removed through morcellation or mini-laparotomy.

Care is taken to avoid tissue spillage, particularly in cases where undetected malignancy is a concern.

Closure and Hemostasis

The cervical stump may be cauterized or sutured to prevent bleeding.

The pelvis is irrigated, and trocars are removed with closure of port sites.

Advantages of LSH

Laparoscopic supracervical hysterectomy offers several benefits:

Minimally invasive: smaller incisions, less pain, and quicker recovery compared to open surgery.

Preservation of cervix: may help maintain pelvic floor support and reduce risk of vaginal vault prolapse.

Potential sexual benefits: some women report better sexual function when the cervix is preserved.

Reduced operative time and blood loss compared to total laparoscopic hysterectomy.

Shorter hospital stay, often allowing same-day or next-day discharge.

Risks and Limitations

Like any surgical procedure, LSH carries risks:

Cervical stump bleeding or cyclic bleeding if residual endometrium remains.

Future cervical disease, including dysplasia or cancer, requiring continued Pap smear screening.

Morcellation risks: in rare cases, undiagnosed uterine malignancies may be spread during morcellation.

Surgical complications such as injury to bladder, bowel, or ureters.

Recurrence of symptoms if underlying endometriosis or adenomyosis affects remaining tissue.

Recovery and Postoperative Care

Recovery after LSH is generally faster than with abdominal hysterectomy. Patients may resume normal activities within 2–3 weeks, compared to 6–8 weeks for open procedures. Postoperative care includes:

Pain management with oral analgesics.

Early ambulation to prevent thromboembolic complications.

Avoidance of heavy lifting or strenuous activities for a few weeks.

Continued cervical screening, since the cervix remains intact.

Comparison with Total Laparoscopic Hysterectomy

LSH differs from Total Laparoscopic Hysterectomy (TLH) in that the cervix is preserved. While TLH eliminates the risk of future cervical disease, LSH may provide advantages in terms of shorter operative time, less dissection, and potential benefits for pelvic support. The choice between the two should be individualized, based on patient preference, clinical findings, and surgeon expertise.

Conclusion

Laparoscopic Supracervical Hysterectomy represents a safe, effective, and minimally invasive option for women requiring hysterectomy for benign gynecological conditions. By removing the uterine body while preserving the cervix, this procedure offers unique advantages in pelvic anatomy preservation, recovery, and patient satisfaction. However, careful patient selection, meticulous surgical technique, and ongoing cervical surveillance are essential to ensure long-term success. As minimally invasive surgery continues to evolve, LSH remains a valuable procedure in the gynecological surgeon’s armamentarium.