title: Subtotal versus total laparoscopic hysterectomy: could women sexual function recovery overcome the surgical outcomes in pre-operatory decision making?
abstract: OBJECTIVE
  Hysterectomy is the most common surgical procedure performed in gynecology and, in over 95% of the cases, does not necessarily require the removal of the uterine cervix to be completed successfully. In clinical practice, however, less than 20% of gynecologists offer patients the possibility to express a personal preference concerning the choice between total laparoscopic hysterectomy (TLH) and laparoscopic subtotal hysterectomy (LSH). The aim of this study is to compare patients who have undergone TLH versus LSH for benign uterine diseases in terms of intra-operative/peri-operative surgical outcomes and short-term recovery of sexual function.
  
  
  METHODS
  We performed an observational, retrospective study on 478 women who underwent hysterectomy for benign uterine disease at Gyn/Ob Clinic, Department of Women's and Children's Health of Padua University between January 2003 and December 2012. Surgical data were recorded. We investigated and compared outcomes between the two groups of patients (TLH vs LSH) in terms of the following: surgical complications rate, post-operative therapy, women satisfaction and sexual activity recovery.
  
  
  RESULTS
  We found that operating time and length of hospital stay were significantly lower in patients who underwent LSH. A higher rate of post-operative fever was reported in the TLH treatment group although antibiotic prophylaxis was implemented in a similar fashion for both groups. At 60-70 days following surgery, women of LSH group reported a greater ease in recovery of sexual function as opposed to those who underwent TLH.
  
  
  CONCLUSIONS
  The advantages and potential drawbacks of both procedures need to be discussed with women presenting with benign disease. LSH is a reasonable option for women, representing both an excellent minimally invasive approach in a proper clinical setting and an appropriate procedure for those women who prefer conservative surgery.
authors.affiliation: Department of Women's and Children's Health, Obstetrics and Gynecology Clinic, University of Padua, Padua, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Saccardi
authors.forename: Salvatore
authors.initials: S
authors.lastname: Gizzo
authors.forename: Marco
authors.initials: M
authors.lastname: Noventa
authors.forename: Michela
authors.initials: M
authors.lastname: Quaranta
authors.forename: Shara
authors.initials: S
authors.lastname: Borgato
authors.forename: Lorena
authors.initials: L
authors.lastname: Conte
authors.forename: Nicola
authors.initials: N
authors.lastname: Pluchino
authors.forename: Pietro
authors.initials: P
authors.lastname: Litta
mesh_terms: D000328:Adult; D003657:Decision Making; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000379:methods*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D063868:Patient Outcome Assessment; D059035:Perioperative Period; D011183:Postoperative Complications / Q000453:epidemiology; D020127:Recovery of Function; D012189:Retrospective Studies; D012725:Sexual Behavior; D016896:Treatment Outcome; D014591:Uterine Diseases / Q000601:surgery*