title: Is cervix removal associated with patient-centered outcomes of pain, dyspareunia, well-being and satisfaction after laparoscopic hysterectomy?
abstract: OBJECTIVE
  To determine the effect of cervix removal at hysterectomy on patient-centered outcomes including post-operative pain, dyspareunia, well-being, and overall satisfaction during the 3-month post-operative period.
  
  
  METHODS
  This is a prospective cohort study of 228 women who underwent elective abdominal, laparoscopic and robotic hysterectomy without concomitant urogynecological or cancer-related procedures, at the Henry Ford Hospital (Detroit, MI). Participants completed a baseline survey evaluating quality of life measures including pain, well-being, sexual and daily function and repeated this survey at serial intervals through 12 weeks post-operatively. Medical record review was performed to confirm demographic and obtain surgical data.
  
  
  RESULTS
  Hierarchical generalized linear models were used to model the trajectory of pain, well-being and satisfaction over the course of the post-surgical period. Subanalysis including only laparoscopic cases was performed. There was no difference in satisfaction (p = 0.48, OR 0.80 [CI 95% 0.43, 1.48]), well-being (p = 0.55, OR 1.12 [CI 95% 0.84, 1.79]), or dyspareunia (p = 0.57, OR 0.75 [CI 95% 0.27, 2.04]) scores between laparoscopic/robotic supracervical and total hysterectomy groups. This was unchanged when all hysterectomy approaches were included in analysis. Cervix removal was associated with higher pain scores with all surgical approaches although this did not reach statistical significance.
  
  
  CONCLUSIONS
  Patient-centered outcomes suggest overall equivalent tolerance of supracervical and total hysterectomy procedures with a trend towards short-term pain improvement with cervical retention.
authors.affiliation: Department of Women's Health Services, West Bloomfield Henry Ford Hospital, 6777 W Maple Road, West Bloomfield, 48322, USA, schiff.lauren@gmail.com.
authors.forename: Lauren
authors.initials: L
authors.lastname: Schiff
authors.forename: Ganesa
authors.initials: G
authors.lastname: Wegienka
authors.forename: Roopina
authors.initials: R
authors.lastname: Sangha
authors.forename: David
authors.initials: D
authors.lastname: Eisenstein
mesh_terms: D000328:Adult; D002584:Cervix Uteri / Q000601:surgery*; D015331:Cohort Studies; D004414:Dyspareunia / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010149:Postoperative Pain / Q000453:epidemiology; D017060:Patient Satisfaction; D011446:Prospective Studies; D011788:Quality of Life; D012371:Robotics