The influence on resection line during supracervical hysterectomy: physiological extension of endometrial cells in the cervix uteri
Journal Title: Journal of the Turkish-German Gynecological Association - Year 2021, Vol 22, Issue 1
Abstract
Objective: A straight resection of corpus uteri using the sacrouterine ligament as landmark is a common method during supracervical hysterectomy. Subsequent spotting rates of up to 25% suggest the existence of residual endometrial glands in the remaining cervical tissue, casting doubt on the landmark qualities of the sacrouterine ligament. Fifty-one females who underwent total laparoscopic hysterectomy for benign diseases were investigated. Material and Methods: Macroscopic uterine parameters were determined during operation. First appearance of endometrium cells, complete disappearance of endometrial cells in the cervix and others were measured microscopically with reference to the external cervical orifice. Associations were described using odds ratio with 95% confidence interval and p-value <0.05. Results: The region of the cervix, in which exclusively cervical glands are found, is relatively small but varies considerably around the mean (mean, 23.3 mm, range, 10 to 35 mm). In this cohort in a remnant cervical stump of 23 mm length, endometrial glands would be found in 51%. There was no correlation between full cervical length and uterine parameters but smaller uteri tended to be associated with deeper endometrial penetration. Conclusion: There is a discrepancy between common definition and histological findings concerning the cervix uteri. Our findings indicate that the sacral uterine ligament is not suitable as an anatomic landmark for the laparoscopic supracervical hysterectomy operation. Regarding the distribution pattern of endometrial glands in the isthmic zone, a deep conical excision seems to better prevent subsequent spotting than a straight resection with thermocoagulation of the remaining cervical canal.
Authors and Affiliations
Carolin Spuentrup, Elke Wendt, Marc Banerjee, Jörg Schmitz, Martin Hellmich, Günter-Karl Noé
Keywords
Related Articles
- EP ID EP693540
- DOI 10.4274/jtgga.galenos.2021.2020.0209
- Views 96
- Downloads 0
Telephone interview in urogynecology in the era of COVID-19 pandemic
Objective: During the Coronavirus disease-2019 (COVID-19) pandemic deferable access, including non-urgent outpatient visits, have been suspended. In our practice non-urgent routine visits for pelvic floor symptom assessm...
Effect of vaginal douching on vaginal flora and genital infection
Objective: "This study aimed at examining the effect of vaginal douching (VD), which is a traditional and cultural application, on the vaginal flora and genital infections. Material and Methods: This descriptive study i...
Robotic versus laparoscopic hysterectomy; comparison of early surgical outcomes
Objective: To compare early surgical outcomes of robotic assisted laparoscopic hysterectomy with laparoscopic hysterectomy for benign diseases, in terms of operation time, estimated blood loss (EBL), perioperative compli...
A comparison of antenatally and intraoperatively diagnosed cases of placenta accreta spectrum
Objective: To assess the effect of antenatal diagnosis of placenta accreta spectrum (PAS) on fetomaternal outcomes. Material and Methods: This was a retrospective cohort study conducted from January 2017 to December 201...
Selective fetal reduction in monochorionic twins: Preliminary experience
Objective: In complicated mono-chorionic twin pregnancies, vaso-occlusive techniques like bipolar cord coagulation (BPCC), radiofrequency ablation (RFA), interstitial laser ablation (ILA) of cord and fetoscopy guided cor...