{"paper_id":"3953d1b7-afd8-4367-a2e1-5b66355007fa","body_text":"Abstract\nCervical stump extirpation (trachelectomy) is the removal of the cervix following supracervical hysterectomy. Subtotal or supracervical hysterectomy is an alternative to total hysterectomy (removal of uterine fundus and cervix) in women undergoing hysterectomy for many benign indications. There are several benefits to supracervical hysterectomy including reduced complications, shorter hospital stay, and faster resumption of activity; in addition, mesh complications are reduced when hysterectomy is done in conjunction with an abdominal sacrocolopexy. However, women considering supracervical hysterectomy should be counseled regarding risks of cervical retention, including need for cervical screening according to current guidelines, as well as the potential need for future surgery to remove the cervical stump. With increases in minimally invasive surgical techniques, many women will elect to undergo supracervical hysterectomy: therefore, it is likely that most gynecologists will encounter patients that require trachelectomy. In this chapter, we will review the indications for trachelectomy, advantages and disadvantages of different routes of access for trachelectomy, as well as complications associated with removing the cervix following subtotal hysterectomy.\nDisclosures\nThe authors report no conflicts of interest; There was no financial support for this research.\nAccess this chapter\nTax calculation will be finalised at checkout\nPurchases are for personal use only\nSimilar content being viewed by others\nReferences\nTan-Kim J, Menefee SA, Luber KM, Nager CW, Lukacz ES. Prevalence and risk factors for mesh erosion after laparoscopic-assisted sacrocolpopexy. Int Urogynecol J. 2011;22(2):205–12. doi:10.1007/s00192-010-1265-3.\nBensinger G, Lind L, Lesser M, Guess M, Winkler HA. Abdominal sacral suspensions: analysis of complications using permanent mesh. Am J Obstet Gynecol. 2005;193(6):2094–8. doi:10.1016/j.ajog.2005.07.066.\nThom CH, Dunne TJ, Livornese G. Vaginal cervicectomy. Obstet Gynecol. 1967;30(4):473–80.\nJones DE, Shackelford DP, Brame RG. Supracervical hysterectomy: back to the future? Am J Obstet Gynecol. 1999;180(3 Pt 1):513–5.\nMunro MG. Supracervical hysterectomy: a time for reappraisal. Obstet Gynecol. 1997;89(1):133–9.\nBrown JS, Sawaya G, Thom DH, Grady D. Hysterectomy and urinary incontinence: a systematic review. Lancet. 2000;356(9229):535–9. doi:10.1016/S0140-6736(00)02577-0.\nKilkku P, Gronroos M, Hirvonen T, Rauramo L. Supravaginal uterine amputation vs. hysterectomy. Effects on libido and orgasm. Acta Obstet Gynecol Scand. 1983;62(2):147–52.\nLearman LA, RL Jr S, Varner RE, McNeeley SG, Goodman-Gruen D, Richter HE, Lin F, Showstack J, Ireland CC, Vittinghoff E, Hulley SB, Washington AE. Total or Supracervical Hysterectomy Research G. A randomized comparison of total or supracervical hysterectomy: surgical complications and clinical outcomes. Obstet Gynecol. 2003;102(3):453–62.\nGreer WJ, Richter HE, Wheeler TL, Varner RE, Szychowski JM, Kuppermann M, Learman LA. Long-term outcomes of the total or supracervical hysterectomy (TOSH) trial. Female Pelvic Med Reconstr Surg. 2010;16(1):49–57. doi:10.1097/SPV.0b013e3181cec343.\nLearman LA, RL Jr S, Varner RE, Richter HE, Lin F, Ireland CC, Kuppermann M, Vittinghoff E, Showstack J, Washington AE, Hulley SB. Medicine or Surgery Research G. Hysterectomy versus expanded medical treatment for abnormal uterine bleeding: clinical outcomes in the medicine or surgery trial. Obstet Gynecol. 2004;103(5 Pt 1):824–33. doi:10.1097/01.AOG.0000124272.22072.6f.\nKuppermann M, Summitt Jr RL, Varner RE, McNeeley SG, Goodman-Gruen D, Learman LA, Ireland CC, Vittinghoff E, Lin F, Richter HE, Showstack J, Hulley SB, Washington AE. Total or Supracervical Hysterectomy Research G. Sexual functioning after total compared with supracervical hysterectomy: a randomized trial. Obstet Gynecol. 2005;105(6):1309–18. doi:10.1097/01.AOG.0000160428.81371.be.\nThakar R, Ayers S, Clarkson P, Stanton S, Manyonda I. Outcomes after total versus subtotal abdominal hysterectomy. N Engl J Med. 2002;347(17):1318–25. doi:10.1056/NEJMoa013336.\nPratt JH, Jefferies JA. The retained cervical stump. A 25-year experience. Obstet Gynecol. 1976;48(6):711–5.\nDecker DG, Hunt AB, Fricke RE, Nelson GA. Carcinoma of the cervical stump. American journal of obstetrics and gynecology. 1957;73(5):974–81. discussion, 981–74\nGimbel H, Zobbe V, Andersen BM, Filtenborg T, Gluud C, Tabor A. Randomised controlled trial of total compared with subtotal hysterectomy with one-year follow up results. BJOG: Inter J Obstet Gynaecol. 2003;110(12):1088–98.\nBoosz A, Lermann J, Mehlhorn G, Loehberg C, Renner SP, Thiel FC, Schrauder M, Beckmann MW, Mueller A. Comparison of re-operation rates and complication rates after total laparoscopic hysterectomy (TLH) and laparoscopy-assisted supracervical hysterectomy (LASH). Eur J Obstet Gynecol Reprod Biol. 2011a;158(2):269–73. doi:10.1016/j.ejogrb.2011.04.021.\nWelch JS, Counseller VS, Malkasian Jr GD. The vaginal removal of the cervical stump. Surg Clin North Am. 1959;39(4):1073–84.\nBoosz A, Lermann J, Mehlhorn G, Renner SP, Thiel FC, Hartmann A, Beckmann MW, Mueller A. Is laparoscopic extirpation of the cervical stump after laparoscopic supracervical hysterectomy justified in women with incidentally found atypical endometrial hyperplasia? J Laparoendosc Adv Surg Tech A. 2011b;21(8):705–9. doi:10.1089/lap.2010.0497.\nMayo CH, Mayo C. Carcinoma of the cervical stump following subtotal hysterectomy. Ann Surg. 1931;93(6):1215–9.\nHilger WS, Pizarro AR, Magrina JF. Removal of the retained cervical stump. Am J Obstet Gynecol. 2005;193(6):2117–21. doi:10.1016/j.ajog.2005.07.015.\nPasley WW. Trachelectomy: a review of fifty-five cases. Am J Obstet Gynecol. 1988;159(3):728–32.\nOkaro EO, Jones KD, Sutton C. Long term outcome following laparoscopic supracervical hysterectomy. BJOG: Inter J Obstet Gynaecol. 2001;108(10):1017–20.\nNezhat CH, Nezhat F, Roemisch M, Seidman DS, Nezhat C. Laparoscopic trachelectomy for persistent pelvic pain and endometriosis after supracervical hysterectomy. Fertil Steril. 1996;66(6):925–8.\nShull BL, Bachofen C, Coates KW, Kuehl TJ. A transvaginal approach to repair of apical and other associated sites of pelvic organ prolapse with uterosacral ligaments. Am J Obstet Gynecol. 2000;183(6):1365–73. discussion 1373-64 doi:10.1067/mob.2000.110910.\nAuthor information\nAuthors and Affiliations\nCorresponding author\nEditor information\nEditors and Affiliations\nRights and permissions\nCopyright information\n© 2018 Springer International Publishing Switzerland\nAbout this chapter\nCite this chapter\nMueller, M.G., Kenton, K. (2018). Trachelectomy: Removal of Cervical Stump Following Supracervical Hysterectomy. In: Alkatout, I., Mettler, L. (eds) Hysterectomy. Springer, Cham. https://doi.org/10.1007/978-3-319-22497-8_121\nDownload citation\nDOI: https://doi.org/10.1007/978-3-319-22497-8_121\nPublished:\nPublisher Name: Springer, Cham\nPrint ISBN: 978-3-319-22496-1\nOnline ISBN: 978-3-319-22497-8\neBook Packages: MedicineMedicine (R0)","source_license":"CC0","license_restricted":false}