{"paper_id":"4de2c7b7-287a-44c8-8165-a548399ca4d1","body_text":"Abstract\nPurpose\nTo determine the effect of cervix removal at hysterectomy on patient-centered outcomes including post-operative pain, dyspareunia, well-being, and overall satisfaction during the 3-month post-operative period.\nMethods\nThis is a prospective cohort study of 228 women who underwent elective abdominal, laparoscopic and robotic hysterectomy without concomitant urogynecological or cancer-related procedures, at the Henry Ford Hospital (Detroit, MI). Participants completed a baseline survey evaluating quality of life measures including pain, well-being, sexual and daily function and repeated this survey at serial intervals through 12 weeks post-operatively. Medical record review was performed to confirm demographic and obtain surgical data.\nResults\nHierarchical generalized linear models were used to model the trajectory of pain, well-being and satisfaction over the course of the post-surgical period. Subanalysis including only laparoscopic cases was performed. There was no difference in satisfaction (p = 0.48, OR 0.80 [CI 95% 0.43, 1.48]), well-being (p = 0.55, OR 1.12 [CI 95% 0.84, 1.79]), or dyspareunia (p = 0.57, OR 0.75 [CI 95% 0.27, 2.04]) scores between laparoscopic/robotic supracervical and total hysterectomy groups. This was unchanged when all hysterectomy approaches were included in analysis. Cervix removal was associated with higher pain scores with all surgical approaches although this did not reach statistical significance.\nConclusions\nPatient-centered outcomes suggest overall equivalent tolerance of supracervical and total hysterectomy procedures with a trend towards short-term pain improvement with cervical retention.\nSimilar content being viewed by others\nReferences\nReich H, De Caprio J, McGlynn F (1989) Laparoscopic hysterectomy. J Gynecol Surg 5:213–216\nChoosing the route of hysterectomy for benign disease. ACOG committee opinion no. 444. American college of obstetricians and gynecologists. Obstet Gynecol 114:1156–1158\nLethaby A, Ivanova V, Johnson N (2006) Total versus subtotal hysterectomy for benign gynaecological conditions. Cochrane database of systematic reviews. Issue 2. Art no.: CD004993\nHilger WS, Pizarro AR, Magrina JF (2005) Removal of the retained cervical stump. Am J Obstet Gynecol 193:2117–2121\nEl Mowafi D, Madkour W, Lall C, Wenger JM (2004) Laparoscopic supracervical hysterectomy versus laparoscopic-assisted vaginal hysterectomy. J Am Assoc Gyecol Laparosc 11(2):175–180\nWallwiener M, Taran F, Rothmund R. (2013) Laparoscopic supracervical hysterectomy (LSH) versus total laparoscopic hysterectomy (TLH): an implementation study in 1,952 patients with an analysis of risk factors for conversion to laparotomy and complications, and of procedure-specific re-operations. Arch Gynecol Obstet [Epub ahead of print]\nLearman LA, Summitt RL Jr, 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 (TOSH) Research Group (2003) A randomized comparison of total or supracervical hysterectomy: surgical complications and clinical outcomes. Obstet Gynecol 102(3):453–462\nZobbe V, Gimbel H, Andersen BM et al (2004) Sexuality after total vs. subtotal hysterectomy. Acta Obstet Gynecol Scand 83(2):191–196\nKuppermann M, Summitt RL Jr, Varner RE et al (2005) Sexual functioning after total compared with supracervical hysterectomy: a randomized trial. Obstet Gynecol 105:1309–1318\nRobert M, Soraisham A, Suave R (2008) Postoperative urinary incontinence after total abdominal hysterectomy or supracervical hysterectomy: a metaanalysis. Am J Obstet Gynecol 198:264–265\nGreer WJ et al (2010) Long-term outcomes of the total or supracervical hysterectomy (TOSH) trial. Female Pelvic Med Reconstr Surg 16(1):49–57\nFlory N, Bissonette F, Amsel RT et al (2006) The psychosocial outcomes of total and subtotal hysterectomy: a randomized controlled trial. J Sex Med 3:483–491\nKives S, Lefebvre G, Wolfman W, Leyland N, Allaire C, Awadalla A, Best C, Leroux N, Potestio F, Rittenberg D, Soucy R, Singh S (2010) Supracervical hysterectomy. J Obstet Gynaecol Can 32(1):62–68\nSupracervical hysterectomy (2007) ACOG committee opinion no 388. American college of obstetricians and gynecologists. Obstet Gynecol 100:1215–1217\nden Breejen EME, Nelen WLDM, Schol SFE, Kremer JAM, Hermens RPMG (2013) Development of guideline-based indicators for patients-centeredness in fertility care: what patients add. Human Reprod 28(4):987–996\nSrikrishna S, Robinson D, Cardozo L (2010) A longitudinal study of patient and surgical goal achievement 2 years after surgery following pelvic floor dysfunction surgery. BJOG 117(12):1504–1511\nKafy S, Al-Sannan B, Kabli N, Tulandi T (2009) Patient satisfaction after laparoscopic total or supracervical hysterectomy. Gynecol Obstet Invest 67(3):169–172\nHeliovaara-Peippo S, Hurskainen R, Teperi J, Aalto AM, Grenman S, Helmesmaki K, Jokela M, Kivela A et al. (2013) Quality of life costs of levonorgestrel-releasing intrauterine system or hysterectomy in the treatment of menorrhagia: a 10 year randomized control trial. Am J Obstet Gynecol. doi:10.1016/j.ajog.2013.08.041\nConflict of interest\nWe declare that we have no conflicts of interest.\nAuthor information\nAuthors and Affiliations\nCorresponding author\nRights and permissions\nAbout this article\nCite this article\nSchiff, L., Wegienka, G., Sangha, R. et al. Is cervix removal associated with patient-centered outcomes of pain, dyspareunia, well-being and satisfaction after laparoscopic hysterectomy?. Arch Gynecol Obstet 291, 371–376 (2015). https://doi.org/10.1007/s00404-014-3420-4\nReceived:\nAccepted:\nPublished:\nIssue date:\nDOI: https://doi.org/10.1007/s00404-014-3420-4","source_license":"CC0","license_restricted":false}