2° CORSO ORISTANESE SEGi
Esistono indicazioni alla STLH?
Valerio Mais
Clinica Ostetrica
Università di Cagliari
2° CORSO ORISTANESE SEGi
Esistono indicazioni alla STLH?
Esistono indicazioni alla isterectomia subtotale?
Esistono indicazioni alla isterectomia?
Quali controindicazioni alla isterectomia subtotale?
Quali controindicazioni alla via laparoscopica?
2° CORSO ORISTANESE SEGi
Esistono indicazioni alla isterectomia subtotale?
= Esistono indicazioni alla isterectomia?
The plaudit for the first abdominal hysterectomy with a survivor is all
American, and goes to Walter Burnham, who performed the operation
in Lowell, Massachusetts, in 1853.
This operation was performed in the early days of anesthesia, and the
ether caused the patient to vomit; thus, when a massive incision was
made from the sternum to the pubis, a large myomatous uterus was
extruded, although Burnham was anticipating a massive ovarian cyst.
It proved impossible to replace the massive myoma, and Burnham had
little choice but to proceed with a subtotal hysterectomy (SH), tying
off both uterine arteries.
The patient recovered, and that the original diagnosis was incorrect
should not detract from Burnham’s achievement.
Sutton C. Past, Present, and Future of Hysterectomy.
Journal of Minimally Invasive Gynecology (2010)
2° CORSO ORISTANESE SEGi
Esistono indicazioni alla isterectomia subtotale?
= Esistono indicazioni alla isterectomia?
Until the 1930s, the universal approach to hysterectomy
was the subtotal procedure,
with reduced risk of pelvic infection
and of bladder and ureter injury.
However, primarily in the preantibiotic era,it was performed
to reduce the risk of ascending infection and peritonitis,
which was almost invariably fatal.
Sutton C. Past, Present, and Future of Hysterectomy.
Journal of Minimally Invasive Gynecology (2010)
2° CORSO ORISTANESE SEGi
Quali controindicazioni alla isterectomia subtotale?
Not until 1929 was the first total hysterectomy performed by Richardson
in the United States, who was concerned about the problem of retaining
the cervix because of the risk of development of cervical stump carcinoma.
It is extraordinary, in retrospect, to think that this concept completely
revolutionized the way hysterectomy was performed, although
stage-by-stage cervical stump carcinoma is associated
with the same 5-year survival rate
as cervical carcinoma when the uterus is removed at radical surgery.
Sutton C. Past, Present, and Future of Hysterectomy.
Journal of Minimally Invasive Gynecology (2010)
2° CORSO ORISTANESE SEGi
Quali controindicazioni alla isterectomia subtotale?
This radical change in the way hysterectomy was performed
was without any evidence-based data
because even before the days of cervical screening,
the actual incidence of neoplastic change in retained cervical stumps
was only 0.4% in 6600 cases collected in the United States,
and 0.1% in Finland.
Jimmerson and Merrill and Lyons have pointed out that this is similar
to the rate of vaginal cancer after TAH,
yet no one has seriously recommended removal of the vagina at hysterectomy
as prophylaxis against this.
Sutton C. Past, Present, and Future of Hysterectomy.
Journal of Minimally Invasive Gynecology (2010)
2° CORSO ORISTANESE SEGi
Quali indicazioni alla isterectomia subtotale?
ovvero
Quali vantaggi con la isterectomia subtotale?
a) prevenzione delle infezioni ascendenti e della peritonite pelvica
b) prevenzione dei danni al retto in caso di endometriosi profonda infiltrante
c) prevenzione della deiscenza della sutura vaginale in pazienti epatopatiche ascitiche
2° CORSO ORISTANESE SEGi
LINEE GUIDA LAPAROTOMIA
SOGC CLINICAL PRACTICE GUIDELINE. J Obstet Gynaecol Can 2010;32(1):62–68
2° CORSO ORISTANESE SEGi
LINEE GUIDA LAPAROTOMIA
SOGC CLINICAL PRACTICE GUIDELINE. J Obstet Gynaecol Can 2010;32(1):62–68
2° CORSO ORISTANESE SEGi
LINEE GUIDA LAPAROTOMIA
SOGC CLINICAL PRACTICE GUIDELINE. J Obstet Gynaecol Can 2010;32(1):62–68
2° CORSO ORISTANESE SEGi
L’avvento della chirurgia laparoscopica
TAH, which includes removal of the cervix in continuity with the body of the uterus,
remains the most popular method of hysterectomy,
and the ratio of subtotal abdominal hysterectomy to total hysterectomy
in the United Kingdom is low, at 0.04,
whereas in the Scandinavian countries, the ratio is 0.56.
The percentage of subtotal hysterectomies in Denmark
increased by nearly 500% between 1988 and 1998,
and this may well reflect the influence of laparoscopic surgery.
Sutton C. Past, Present, and Future of Hysterectomy.
Journal of Minimally Invasive Gynecology (2010)
2° CORSO ORISTANESE SEGi
L’avvento della chirurgia laparoscopica
 Nel 1988 Reich esegue la prima isterectomia totale laparoscopica
(Reich H,DeCaprio J,McGlynn F. Laparoscopic hysterectomy. J Gynaecol Surg. 1989;5:213
215.)
 Nel 1991 Semm propone il methodo CASH per l’isterectomia subtotale laparoscopica
(Semm K. Hysterectomy via laparatomy or pelviscopy: a new CASH method without colpotomy
[German]. Geburtshilfe Frauenheilk.1991;51:996–1003.)
 Nel 1993 Lyons pubblica i risultati delle prime isterectomie subtotali laparoscopiche
(Lyons TL. Laparoscopic supra-cervical hysterectomy: a comparison of morbidity and mortality
results with laparoscopic assisted vaginal hysterectomy. J Reprod Med. 1993;38:738–763.)
Sutton C. Past, Present, and Future of Hysterectomy.
Journal of Minimally Invasive Gynecology (2010)
2° CORSO ORISTANESE SEGi
Indicazioni alla isterectomia subtotale laparoscopica?
ovvero
Vantaggi con l’isterectomia subtotale laparoscopica?
a) prevenzione dei danni al retto in caso di endometriosi profonda infiltrante
b) riduzione dei rischi di danno agli ureteri
c) riduzione del tempo operatorio
2° CORSO ORISTANESE SEGi
Indicazioni alla isterectomia subtotale laparoscopica?
ovvero
Vantaggi con l’isterectomia subtotale laparoscopica?
Cipullo L et al., JSLS (2009)
2° CORSO ORISTANESE SEGi
Indicazioni alla isterectomia subtotale laparoscopica?
ovvero
Vantaggi con l’isterectomia subtotale laparoscopica?
Cipullo L et al., JSLS (2009)
2° CORSO ORISTANESE SEGi
LINEE GUIDA LAPAROSCOPIA
AAGL Practice Guidelines for Laparoscopic Subtotal/Supracervical Hysterectomy (LSH)
Journal of Minimally Invasive Gynecology, Vol 21, No 1, January/February 2014
2° CORSO ORISTANESE SEGi
LINEE GUIDA LAPAROSCOPIA
AAGL Practice Guidelines for Laparoscopic Subtotal/Supracervical Hysterectomy (LSH)
Journal of Minimally Invasive Gynecology, Vol 21, No 1, January/February 2014
2° CORSO ORISTANESE SEGi
LINEE GUIDA LAPAROSCOPIA
AAGL Practice Guidelines for Laparoscopic Subtotal/Supracervical Hysterectomy (LSH)
Journal of Minimally Invasive Gynecology, Vol 21, No 1, January/February 2014
2° CORSO ORISTANESE SEGi
Quali controindicazioni alla isterectomia subtotale?
TUMORI MALIGNI DELL’UTERO
ANOMALIE DELLA CITOLOGIA CERVICALE PRESENTI O ANAMNESTICHE
CARCINOMA DELLA CERVICE UTERINA
CARCINOMA DELL’ENDOMETRIO
SARCOMA DELL’UTERO