Laparoscopic Supracervical Hysterectomy safer than total Laparoscopic Hysterectomy among patients with uterine fibroids: Study

This cohort study used data from the American College of Surgeons National Surgical Quality Improvement Program database of cases from 2012 to 2020. The analysis involved 50,796 women who had total laparoscopic hysterectomy (44,413 patients) or laparoscopic supracervical hysterectomy (6383 patients) performed for the purpose of uterine fibroids. Researchers compared 30-day postoperative complications, classified based on the Clavien-Dindo classification. Variables like age, body mass index, race, comorbidities, American Society of Anesthesiologists classification, uterine weight, and other surgical procedures were compared using multivariate regression to identify their role in postoperative results.

Key Findings

Operative Time:

• Mean operative time was considerably less for total laparoscopic hysterectomy (143.0 minutes) than for laparoscopic supracervical hysterectomy (150.6 minutes, p<.001).

• Uterine Weight

• The rate of patients with uterine weights over 250 g was lower in the total laparoscopic hysterectomy group (39.4%) than in the laparoscopic supracervical hysterectomy group (45.1%, p<0.001).

Overall Complication Rates:

• Any complications after the operation were more in the group that underwent total laparoscopic hysterectomy (6.6%) than in the group that underwent laparoscopic supracervical hysterectomy (5.3%, p<0.001).

Major Complications:

• Major complications were also more with total laparoscopic hysterectomy (2.7%) than with laparoscopic supracervical hysterectomy (1.6%, p<0.001).

Minor Complications:

• Rates of minor complications did not significantly differ between both groups (total laparoscopic hysterectomy: 4.4%, laparoscopic supracervical hysterectomy: 4.1%, p=0.309).

Adjusted Odds Ratios:

• Laparoscopic supracervical hysterectomy was independently linked with lower risk of any postoperative complication (adjusted OR: 0.79; 95% CI: 0.70–0.88).

• It also carried a much lower risk of major complications (adjusted OR: 0.55; 95% CI: 0.44–0.69).

This research concludes that laparoscopic supracervical hysterectomy has a reduced risk of short-term postoperative complications when compared to total laparoscopic hysterectomy in uterine fibroid patients. These findings reinforce the importance of personalized surgical planning and can aid patients and surgeons to select the ideal minimally invasive hysterectomy method.

Reference:

Meyer R, Hamilton KM, Schneyer RJ, Levin G, Truong MD, Wright KN, Siedhoff MT. Short-term outcomes of minimally invasive total vs supracervical hysterectomy for uterine fibroids: a National Surgical Quality Improvement Program study. Am J Obstet Gynecol. 2025 Apr;232(4):377.e1-377.e10. doi: 10.1016/j.ajog.2024.10.006. Epub 2024 Oct 14. PMID: 39413898.