Vaginal Trachelectomy for Retained Cervical Stump after Supracervical Hysterectomy: Technical Tips and Outcomes

Background and Objectives: The supracervical hysterectomy (SCH) has resulted in a group of patients with a retained cervix at risk of persistent symptoms, who may require a trachelectomy in the future. This study was to evaluate the efficacy of vaginal trachelectomy (VT) after a previous SCH. Methods: This was a prospective study that includes 13 cases with different ages and different complaints, sharing the same primary operation supracervical hysterectomy. They have different pathologies of the SCH specimen but they share the same completion surgery. The surgical outcome was analyzed. Results: Thirteen patients underwent vaginal trachelectomy for recurrent symptoms. The ages of patients were ranged from 37 years to 68 years (Mean ± SD, 56.4 ± 10.7). SCH was most commonly performed for abnormal uterine bleeding AUB (7/13, 53.8%), pelvic mass (5/1, 38.5%), and pelvic pain (1/13, 7.7%), the symptoms leading to vaginal trachelectomy were the same as those leading to supracervical hysterectomy. The median interval time from SCH to seeking medical help for the persistence or recurrence of symptoms and to VT was 2 weeks (1 to 96 weeks). Concomitant procedures were laparoscopic removal of both ovaries in 2 cases and pelvic lymphadenectomy in 1 case. The median length of operation was 45 minutes. In all cases, symptoms leading to trachelectomy resolved completely after surgery, and patients reported a significant improvement. Conclusions: The cervix, left behind at subtotal hysterectomy, requires removal, the vaginal route is probably the safest, and least traumatic. Vaginal radical trachelectomy appears to be feasible and safe for the treatment of endometrial malignancy discovered after supracervical hysterectomy.

Large pelvic mass arising from the cervical stump: A case report

BACKGROUND A large cervical cyst with a cervical high-grade squamous intraepithelial lesion arising from the cervical stump is rare.After supracervical hysterectomy,there is a risk of various lesions occurring in the cervical stump.We review the types and characteristics of cervical stump lesions and compare total hysterectomy with subtotal hysterectomy.Gynecologists should choose the most suitable surgical method based on both the patient’s condition and wishes.If the cervix is retained,patients require a close follow-up.CASE SUMMARY A 57-year-old woman was admitted to the Gynecology Department for a large pelvic mass.Her chief complaint was abdominal distention for two months.She had undergone subtotal supracervical hysterectomy for leiomyoma 14 years prior.Abdominal ultrasonography detected a 9.1 cm×8.5 cm×8.4 cm anechoic mass with silvery fluid in the pelvic cavity and high-risk human papilloma virus 53(HPV53)was positive.The admission diagnosis we first considered was a pelvic mass mimicking carcinoma of the cervical stump.We performed a laparotomy and a rapid frozen biopsy was suggestive of a fibrous cyst wall coated with a high squamous intraepithelial lesion.The pelvic mass was removed,and a bilateral adnexectomy was implemented.Final pathology confirmed that the pelvic mass was a large inflammatory cyst with a cervical high-grade squamous intraepithelial lesion.After successful intervention,the patient was discharged one week after surgery and there was no recurrence of the vaginal stump at 43 mo.CONCLUSION When addressing benign uterine diseases,gynecologists should pay adequate attention to retaining the cervix.If the cervix is retained,patients require a close follow-up.