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Laparoskopische suprazervikale Hysterektomie (LASH)

Laparoscopic supracervical hysterectomy

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Der Gynäkologe Aims and scope

Zusammenfassung

Die laparoskopische suprazervikale Hysterektomie (LASH) ist eine minimal-invasive Methode, die in den 1990er-Jahren zur Therapie der uterinen Blutungsstörung entwickelt wurde. Bislang existiert keine prospektiv randomisierte Studie zum Vergleich der LASH mit einer anderen Hysterektomieform. In einer prospektiv randomisierten Studie zum Vergleich der LASH mit der hysteroskopischen Endometriumresektion zeigten sich keine signifikanten Unterschiede in Bezug auf die Komplikationsrate, die Dauer des Krankenhausaufenthalts sowie die Länge der Rekonvaleszenzphase. Die Patientinnenzufriedenheit war in der LASH-Gruppe jedoch signifikant höher. Retrospektive Untersuchungen zeigen Vorteile der LASH im Vergleich mit der LAVH im Sinne einer kürzeren Operationszeit, kürzerer Hospitalisierung und geringerem Blutverlust. Ein kontrovers diskutierter Aspekt ist die Gefahr des Zervixstumpfkarzinoms nach LASH. Nach den Ergebnissen der bislang verfügbaren Untersuchungen scheint jedoch die Inzidenz des Zervixstumpfkarzinoms nach LASH bei Frauen mit unauffälligen Abstrichergebnissen der Cervix uteri vergleichbar mit der Inzidenz des Scheidenstumpfkarzinoms nach abdominaler Hysterektomie zu sein.

Abstract

Laparoscopic supracervical hysterectomy (LASH) is a minimally invasive procedure that was developed during the 1990s as a novel treatment option for patients with uterine bleeding disorders. To date, prospective randomized trials comparing LASH with either vaginal or abdominal hysterectomy do not exist. A randomized controlled trial that compared LASH with hysteroscopic endometrial resection found that LASH resulted in better patient satisfaction. A retrospective study compared LASH with laparoscopic assisted vaginal hysterectomy and demonstrated reduced operating time, blood loss, hospitalisation and a quicker return to normal activity for patients who underwent LASH. The potential risk of cervical carcinoma in patients with a cervical stump is often controversially discussed. However, results of follow-up studies do not indicate a higher incidence of cervical cancer after LASH compared to the risk of vaginal cuff carcinoma after total hysterectomy.

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  1. Universitätsfrauenklinik Düsseldorf

    D. Rein

  2. Universitätsfrauenklinik Köln

    T. Schmidt

  3. Universitätsfrauenklinik Düsseldorf, Moorenstraße 5, 40225, Düsseldorf

    D. Rein

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Rein, D., Schmidt, T. Laparoskopische suprazervikale Hysterektomie (LASH). Gynäkologe 38, 959–967 (2005). https://doi.org/10.1007/s00129-005-1763-4

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  • DOI: https://doi.org/10.1007/s00129-005-1763-4

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