Comparative evaluation of classical intrafascial-supracervical hysterectomy (CISH) with transuterine mucosal resection as performed by pelviscopy and laparotomy—our first 200 cases

Abstract

A novel way of performing endoscopic intrafascial supracervical hysterectomy is presented. By using the endoscopic approach for dissection as well as uterine extraction using the serrated-edged macro-morcellator, we avoid giving the patient a colpotomy incision and its inherent post-operative discomfort. A further modification involves nearly complete excision (95%) of uterocervical mucosa using a calibrated resection tool, thus eliminating the possible subsequent development of cervical stump neoplasia. Sparing of the cardinal ligament insertion provides support to the cervical stump. Hemorrhage and genitourinary complications are prevented by avoiding dissection of the parametrium at the level of endocervix. Comparison of data of the pelviscopic CISH procedure with the laparotomy approach in our preliminary series (n = 190) confirms our claims as to its safety. Data on long-term postoperative evaluation are ongoing, but the initial reports deny any postoperative discomfort. Larger randomized studies are required to prove its value compared with the existing techniques. We believe that with its multitude of benefits, the classic intrafascial serrated-edged macro-morcellated (SEMM) hysterectomy (= CISH) may emerge as an attractive alternative to conventional hysterectomy.

Pelviscopic Compared to Laparotomic and Vaginal Intrafascial Hysterectomy

“…Figure 7 showed that the uterine weights less than 200 g were removed by IVH and pelviscopic CISH operations, while larger size uteri weighing less than 400 g in average were treated by AH and laparotomy CISH operations. Operating time (1993)(1994) FIGURE 6 Operating time of 368 hysterectomies of patients who underwent hysterectomy at the Department of Obstetrics and Gynaecology University of Kiel (1993)(1994) (1993)(1994) LpCISII FIGURE 7 Uterine weights of 368 hysterectomies of patients who underwent hysterectomy at the Department of Obstetrics and Gynaecology University of Kiel (1993Kiel ( -1994 The shortest period of postoperative hospitalization was found among the patients, undergoing pelviscopic CISH operations (Fig. 8) [21,22].…”

“…From 1950 onwards hysterectomy was almost only performed as total hysterectomy. Since the 1990 interest in supracervical hysterectomy has been re-established because of the introduction of the Classic Intrafascial Supracervical Hysterectomy pelviscopic and laparotomy techniques [3][4][5][6][7][8][9]. Previously, in 1984 (1993)(1994) (per cent), (n=368, 1993-1994) …”

Holmium:YAG Laser Enucleation of the Prostate Combined with Mechanical Morcellation: Preliminary Results

“…These techniques have primarily been applied to laparoscopic removal of intra-abdominal organs or vaginal hysterectomy [10, 11, 12, 13, 14, 15, 16, 17, 18, 19]. A number of instruments and techniques have been described utilising instruments with mechanically operated blades or high-frequency cutting electrodes, however surgical instruments such as ring forceps and digital manipulation have also been advocated.…”

Laparoscopic Hysterectomy and Prolapse: A Multiprocedural Concept

“…14 Different variants evolved, such as laparoscopy-assisted vaginal hysterectomy (LAVH) and LASH, as well as TLH and laparoscopic intrafascial hysterectomy. TLH had a steep learning curve and, in the beginning, a relatively high complication rate.…”