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Laparoskopische suprazervikale Hysterektomie

Laparoscopic supracervical hysterectomy

  • Leitthema
  • Published:
Der Gynäkologe Aims and scope

Zusammenfassung

Die in den 1990er-Jahren entwickelte laparoskopische suprazervikale Hysterektomie (LASH) gewinnt zunehmend an Bedeutung; dennoch gibt es bis heute keine prospektiv randomisierte Studie, welche die LASH mit den anderen Hysterektomietechniken vergleicht. Die Vorteile einer laparoskopisch im Vergleich zu einer abdominal durchgeführten Hysterektomie sind hinreichend bekannt. Trotzdem ist die abdominale Methode, auch fast 20 Jahre nach Durchführung der ersten laparoskopischen Hysterektomie, weiterhin weltweit die dominierende. Befürworter der LASH sind der Meinung, dass die Operation leichter durchzuführen ist, weniger invasiv ist und, im Vergleich zur totalen laparoskopischen Hysterektomie (TLH), eine geringere Rate an operationsbedingten Ureterverletzungen und Infektionen aufweist. Kritiker hingegen halten die postoperativ auftretenden Zervixstumpfprobleme, wie persistierende Blutungen und Schmerzen, und die daraus resultierenden Folgeoperationen für zu belastend für die Patientin. Ziel dieser Arbeit ist es, eine Übersicht über die aktuelle Datenlage zum Stellenwert der LASH zu geben.

Abstract

Laparoscopic supracervical hysterectomy (LASH) is a minimally invasive procedure that was developed during the 1990s. Although LASH has gained in importance, prospective randomized trials comparing LASH with other hysterectomies are very sparse. The benefits of laparoscopic hysterectomy compared with an open abdominal approach are well documented. However, nearly 20 years after the first reports of different techniques of laparoscopic hysterectomy, abdominal hysterectomy is still the predominant surgical technique worldwide. Advocates of LASH suggest that the procedure is easier to perform, is less invasive, and carries a lower risk of ureteric injuries and infectious complications compared with total laparoscopic hysterectomy. Opponents of LASH, however, are concerned with the persistent risk of cervical stump symptoms such as persistent vaginal bleeding and pelvic pain following LASH, causing patient distress and, eventually, repeated surgery. The aim of this work was to screen the actual data for the local value of LASH.

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Authors and Affiliations

  1. Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland

    M. Thill, A. Kavallaris, K. Kelling & K. Diedrich

  2. Klinik für Gynäkologie und Geburtshilfe, St. Elisabeth Krankenhaus, Köln, Köln, Deutschland

    C. Altgassen

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  1. M. Thill
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  2. A. Kavallaris
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  3. K. Kelling
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  4. K. Diedrich
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  5. C. Altgassen
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Correspondence to M. Thill.

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Thill, M., Kavallaris, A., Kelling, K. et al. Laparoskopische suprazervikale Hysterektomie. Gynäkologe 43, 124–131 (2010). https://doi.org/10.1007/s00129-009-2448-1

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