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437 classic intrafascial supracervical hysterectomies in 8 years
1Department of Surgery, Fayette Medical Center, 1035 Temple Avenue North, Fayette, AL 35555, USA.
Study Objective:
To report technical aspects and practical long-term experience with classic intrafascial supracervical hysterectomy (CISH).
Design:
Retrospective evaluation (Canadian Task Force Classification II-2).
Setting:
Local community hospital in rural northwest Alabama.
Patients:
Four hundred thirty-seven women.
Intervention:
The procedure was performed as described originally but with slight modifications (vaginal manipulator, ETS stapler).
Measurements And Main Results:
Follow-up was 44.7 months (range 3-97 mo). Average operating time was 1 hour 10 minutes (range 46 min-6 hrs, 10 min), average blood loss was 68 ml (range 10-765 ml), average length of hospital stay was 22 hours (range 10 hrs-5 days), and average return to work was 14 days (range 3-28 days). Complications were 11 bleeding cervices (7 occurring within 21 days after surgery, and 4 between 2 and 4 yrs after surgery), 1 case of uterine artery bleeding, 1 ileus, 1 pelvic hematoma, and 5 mucoceles between 2 and 27 months postoperatively. There were three conversions, one because of morbid obesity (185 kg) and two because of large uterus:pelvis ratio.
Conclusion:
CISH leaves the pelvic floor intact, has short recuperation and high patient satisfaction, and is cost effective at a low complication rate. It is an advanced laparoscopic procedure, is initially technically challenging, and has a learning curve.