Abstract
New abdominal and vaginal hysterectomy techniques, such as classic intrafascial serrated edged macro-morcellator (SEMM) hysterectomy (CISH), by pelviscopy/laparoscopy or laparotomy, and intrafascial vaginal hysterectomy (IVH), are both essentially supravaginal techniques. It has been claimed that they give a prophylaxis against cervical stump carcinoma by coring out the cervix with the SEMM. We set out to answer two questions: 1) How can vaginosonography help to choose an adequate SEMM diameter so that the cervical mucosa and transformation zone are completely removed, and 2) How often do cervical glands remain after the coring out procedure? We were able to show a good correlation between sonographic and histological morphology by giant and serial sections. In 253 CISH operations, resection of both endocervix and transformation zone was complete in 92.9%. Dysplasias were always removed completely; only 18 cervical cores exhibited healthy glands (retention cysts) in the resection margin. Therefore, CISH procedures should be able to prevent most of the cervical stump carcinomata that follow traditional supravaginal hysterectomy, but only long-term follow-up will give the final proof.
Highlights
The cored-out tissue cylinder is suitable for precise histological evaluation, so that the resection margins may beNew hysterectomy techniques have been developed that examined as in cone biopsies.claim to combine the minimal invasive approach of the supracervical method with the carcinoma prophylaxis of total hysterectomy [1,2]
It is centered on the cervical canal with the aid of a previously placed guide rod and a circular distance holder where it functions as an integral part of the calibrated uterine resection tool (CURT)
We considered classic in- MATERIALS AND METHODStrafascial serrated edged macro-morcellator (SEMM) hysterectomy (CISH) only, if Papanicolaou smear and colposcopic findings were normal; otherwise, a cervical carcinoma had to be ruled out
Summary
Cervix-An Assessment of Laparoscopic and Other lntrafascial Hysterectomy Techniques. It has been claimed that they give a prophylaxis against cervical stump carcinoma by coring out the cervix with the SEMM. We set out to answer two questions: 1) How can vaginosonography help to choose an adequate SEMM diameter so that the cervical mucosa and transformation zone are completely removed, and 2) How often do cervical glands remain after the coring out procedure? In 253 CISH operations, resection of both endocervix and transformation zone was complete in 92.9%. Dysplasias were always removed completely; only 18 cervical cores exhibited healthy glands (retention cysts) in the resection margin. CISH procedures should be able to prevent most of the cervical stump carcinomata that follow traditional supravaginal hysterectomy, but only long-term follow-up will give the final proof
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