Nerve Sparing Hysterectomy
OBJECTIVE:
To evaluate the effect of the new Intrastromal abdominal hysterectomy as a bloodless nerve-sparing method without disturbing the pelvic support system, versus the conventional abdominal hysterectomy. Additionally, to evaluate this method as an alternative procedure to prevent blood loss and enable a shorter hospital stay with fewer complications.
- No Risk for ureter injury
- Reduced operating time and bleeding than total hysterectomy
- Preserves the support ligaments of the cervix and vagina.
- Preserves the neuro-vascular supply in cardinal and utero-sacral ligaments
- Faster cervical headling in 3 weeks, compared 6-8 weeks for vaginal cuff healing
- No risk for vaginal cuff abscess, hematoma, distortion and prolaps
- Faster recovery than total hysterectomy
- No Cyclic (menstrual) bleeding, as with some subtotal hysterectomy.
- No risk for cervical cancer, dysplasia, cervicitis compared to subtotal hysterectomy
METHODS:
The hysterectomy can be performed using the following techniques: conventional, abdominal, vaginal, or laparoscopic assisted vaginal hysterectomy, intrafascial, extrafascial, and lastly the supracervical hysterectomy. The supracervical hysterectomy has been criticized in medical literature due to the number of patients developing cancer in the cervical stump that may lead to fatality. Moreover, it is important to acknowledge that the supercervical hysterectomy is expensive, which is to be attributed to the cost incurred as a result of the preventive measures considered for cancer.
The new intrastromal T.A.H. keeps the cardinal, utereosacral ligament, and vaginal apex unsevered. In the meantime, the entire cervix’s endocervical canal and the T-zone with uterus are removed, whereas the bed and the pericervical stroma remain. In the outer stroma of the cervix is a pericervical bed, and the cervix is removed from this bed.
RESULTS:
There were differences in the average blood loss (Δhemoglobin 1.0 versus 1.4 g/dl, P0.00l), and the average hospital stay (2.7 days versus 3.15 days, P=0.005) was in favor of the study group. There were no post-operation infections, ureter injuries, vaginal vault prolapses, and no post-hysterectomy fistula were seen.
CONCLUSION:
Intrastromal Abdominal Hysterectomy is a bloodless, nerve-sparing technique that does not disturb the pelvic support system. It also proves to be an effective alternative to the traditional hysterectomy, with advantages such as reduced blood loss, shorter hospital stay, and less frequent post-operation complications. Throughout this process, it is imperative that the patient’s fear cervical cancer should not be ignored.