Abstract
The operative methods of total uterine mucosal ablation (TUMA) as well as new abdominal and vaginal hysterectomy techniques are described. Classic intrafascial serrated edged macro-morcellator (SEMM) hysterectomy (CISH) by pelviscopy or laparotomy and intrafascial vaginal hysterectomy (IVH) are techniques that allow the nerve and the blood supply of the pelvic floor to remain intact, mainly because only the ascending branches of the uterine arteries are ligated. TUMA avoids the removal of the uterus altogether and is reserved for hypermenorrhea or menorrhagia without major enlargement of the uterus. Both CISH and IVH reduce the physical trauma of hysterectomy considerably and have the advantages of the supravaginal technique. Prophylaxis against cervical stump carcinoma is assured by coring out the cervix with the SEMM. In patients in whom both procedures are possible, IVH is preferred because it combines the minimal trauma and short operative time of vaginal hysterectomy. The decreased diameter of the cervix after coring out greatly simplifies this type of vaginal hysterectomy, the technique that has always been favored because of its short operative times and minimal trauma.
Highlights
The operative methods of total uterine mucosal ablation (TUMA) as well as new abdominal and vaginal hysterectomy techniques are described
How entifically founded report of a total hysterectomy for much follow-up with Papanicolaou smears might have cancer was given by Wilhelm Alexander Freund from influenced the rate of cervical stump carcinoma has Breslau in 1878 [2]
We considered CISH, TUMA, or intrafascial vaginal hysterectomy (IVH) only if Papanicolaou smear and colposcopic findings were normal; otherwise, a cervical carcinoma had to be ruled out
Summary
The operative methods of total uterine mucosal ablation (TUMA) as well as new abdominal and vaginal hysterectomy techniques are described. TUMA avoids the removal of the uterus altogether and is reserved for hypermenorrhea or menorrhagia without major enlargement of the uterus Both CISH and IVH reduce the physical trauma ofhysterectomy considerably and have the advantages of the supravaginal technique. Other authors do not confirm this [6]; is is indisputable that total hysterectomy requires ligation of the uterine arteries, amputation of the vagina, and destruction of the nervous uterovaginal plexus along with the cardinal ligaments (Fig. 1). All these structures remain intact when supracervical hysterectomy is performed
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