[Intrafascial vaginal hysterectomy (IVH) with or without pelviscopic assistance]

During the past few years, new techniques have supplemented the vaginal and abdominal techniques of hysterectomy, namely, the pelviscopic/laparoscopic methods C*I*S*H* (Classic Intrafascial S*E*M*M* Hysterectomy, S*E*M*M* denoting Serrated Edged Macro-Morcellated) and LAVH (Laparoscopic Assisted Vaginal Hysterectomy). With C*I*S*H*, the uterus is supravaginally removed with pelviscopy and morcellated intraabdominally after having punched out the cervical glandular tissue by means of C*U*R*T* (Calibrated Uterine Resection Tool), whereas with LAVH, the uterus is peeled laparoscopically, but ultimately removed from the abdomen per vaginam. The next method to be developed from C*I*S*H* was, initially, TUMA (Total Uterine Mucosa Ablation) where the residual uterine muscle remains in situ. Following that, IVH (Intrafascial Vaginal Hysterectomy) was developed as a minimal invasive approach. After having punched out the cervical glandular tissue by means of C*U*R*T* (Calibrated Uterine Resection Tool). Hysterectomy is performed with the technique employed up to now with anterior precipitation of the uterus. The cardinal and sacrouterine ligaments, uterine arteries and the vagina remain uninjured. Since no sensitively innervated tissue is transected, this operation is postoperatively largely painless. Likewise, the innervation of the urinary bladder and rectum is not damaged and there is also no impairment of sexual feeling. The time required for the operation corresponds with that of the routine time required so far, when performing vaginal hysterectomy. Vaginal surgery is significantly facilitated by the fact, that the cervix is practically absent when the uterus is precipitated anteriorly.