COMPARATIVE-EVALUATION OF CLASSICAL INTRAFASCIAL SUPRACERVICAL HYSTERECTOMY (CISH) WITH TRANSUTERINE MUCOSAL RESECTION AS PERFORMED BY PELVISCOPY AND LAPAROTOMY - OUR FIRST 200 CASES

A novel way of performing endoscopic intrafascial supracervical hyster ectomy is presented. By using the endoscopic approach for dissection a s well as uterine extraction using the serrated-edged macromorcellator , we avoid giving the patient a colpotomy incision and its inherent po st-operative discomfort. A further modification involves nearly comple te excision (95%) of uterocervical mucosa using a calibrated resection tool, thus eliminating the possible subsequent development of cervica l stump neoplasia. Sparing of the cardinal ligament insertion provides support to the cervical stump. Hemorrhage and genitourinary complicat ions are prevented by avoiding dissection of the parametrium at the le vel of endocervix. Comparison of data of the pelviscopic CISH procedur e with the laparotomy approach in our preliminary series (n = 190) con firms our claims as to its safety. Data on long-term postoperative eva luation are ongoing, but the initial reports deny any postoperative di scomfort. Larger randomized studies are required to prove its value co mpared with the existing techniques. We believe that with its multitud e of benefits, the classic intrafascial serrated-edged macro-morcellat ed (SEMM) hysterectomy (= CISH) may emerge as an attractive alternativ e to conventional hysterectomy.