Ciassical intrafascial SEMM hysterectomy (CISH) is a synthesis of cervical conization. Supracervical amputation and operative laparscopy to constitute a new type of hysterectomy compatible with the consept of minimally invasive and organ
preserving
surgery.
We have experienced of 43 cases of CISH at Cheil General Hospital from November, 1992 to April, 1994. There were three cases where CISH was stopped and total abdominal hysterectomy was done because of the following reasons: the size of the uterus
being
too large to apply endoloop around the cervico-corporeal junction, severe pelvic adhesion and subcutaneous emphysema.
The average age of patients was 43 years old. Indication were 17 cases of uterine myoma (42.5%), 15 cases of adenomyosis(37.5%), 5 cases of ovarian tumor(12.5%), 2 cases of abnormal uterine bleeding (5.0%) and 1 case of endometrial
hyperplasia(2.5%). In
size of uteri, 8 gestational weeks size was the most common, being 14 cases (35.0%), and the size of uteri varied from 6 to 12 gestational weeks.
We have performed subtotal hysterectomy preserving the cervix whereas squamo-columnar junction and endocervical glands being removed to prevent potential occurrence of cervical cancer in future. The cervical shell connected by uterine ligaments
was
preserved to maintain the normal pelvic floor to minimize postoperative infection and to accelerate early recovery.
Initially, the mean operation time was 310 minutes. With accumulation of operator's experience it was reduced to 198 minutes. The hemoglobin was reduced by 1.66gm/dl and the hematocrit by 4.57%. There were 2 cases of massive bleeding during
operation
and 3 cases of minimal cervical bleeding. 2 cases of dysuria, 1 case of febrile morbidity and 1 case of severe headache postoperatively. The average hospitalization was 6 days. The average days of return to domestic activity was 21.5 days.
In conclusion, CISH was compatible with minimally invasive and organ preserving surgery and showed shorter operation time with subsequent quick recovery of patients and the reduction of complications. Moreover, hospitalization can be shortened.
The
important factors in maximizing these advantages of CISH were the experience of the operator, the size of the uterus, and the degree of the pelvic adhesion.
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