Subtotal hysterectomy causes fewer long-term detrimental effects on ovary tissues than total hysterectomy

Abstract

Background. Hysterectomy is the basic surgical procedure of gynecological surgery. Traditionally, it is divided into total hysterectomy (TH) and subtotal hysterectomy (STH) according to the scope of surgery. The ovary is a dynamic organ appended with the uterus, and the uterus provides vascular supply to the developing ovary. However, the long-term impacts of TH and STH on ovary tissues need to be evaluated. Method. In this study, rabbit models of different ranges of hysterectomy were successfully created. The estrous cycle of animals was determined by vaginal exfoliated cell smear 4 months after the operation. The apoptosis rate of ovarian cells in each group was determined by flow cytometry, and the morphology of ovarian tissue and granulosa cells in the control group, triangular hysterectomy group and total hysterectomy group were observed under microscope and electron microscope, respectively. Results. After total hysterectomy, the apoptotic events in ovarian tissues were significantly increased when compared to the sham and triangle hysterectomy group. Increased apoptosis was accompanied with the morphological changes and disrupted organelle structures in ovarian granulosa cells. The follicles in the ovarian tissue were dysfunctional and immature, with more atretic follicles being observed. In contrast, ovary tissues in triangular hysterectomy groups showed no obvious defects on the morphology of ovarian tissue and granulosa cells. Conclusions. Our data suggest that subtotal hysterectomy may serve as an alternative to total hysterectomy, with fewer long-term detrimental effects on ovary tissues.