Subtotal hysterectomy revisited.

The advent of laparoscopic surgery has enabled gynaecologists to re-evaluate the traditional approaches to hysterectomy. Until the 1940's hysterectomy involved retaining the cervix because the simpler operation avoided damage to the ureter and prevented ascending infection, which was an important consideration before the advent of antibiotics. In order to reduce the risk of developing cervical carcinoma the cervix was traditionally removed at hysterectomy over the last 50 years. Since it is possible to remove the area where cervical carcinoma develops and with the development of an effective screening programme for cervical carcinoma, this needs no longer to be a consideration. A more logical approach to laparoscopic hysterectomy would be to retain the cervix but remove the transformation zone and in so doing there is less risk to the ureter, less postoperative urinary dysfunction, virtually no disturbance to the lower genital tract, thus resulting in little or no impairment of sexual enjoyment.