[Vaginal supracervical vs. laparoscopic supracervical hysterectomy, with resection of transcervical and transuterine mucosa].

Indications for the 346 hysterectomies performed in the Department of Obstetrics and Gynecology University of Kiel in the years 1991 till 1994 were myomas with pain, hypermenorrhoea, menorrhagia, recurrent bleedings and endometriosis. The applied hysterectomy technique consisted of supercervical hysterectomy without colpotomy including the resection of the transcervical and transuterine mucosa by laparotomy and via laparoscopy (pelviscopy). Histologically results were divided between fibromas, leiomyomas, adenomyosis and adenomatous hyperplasia. 42 patients where pretreated with hormones and showed a significantly reduced blood loss compared to the non treated patients during surgery. Intra- and postoperative complications were very low. The CISH-technique is an alternate method for vaginal and abdominal total hysterectomy via laparotomy or via laparoscopy. Gynecological indications for hysterectomies presents the following advantages. 1. CISH via pelviscopy: Prophylaxis against the development of cervical cancer, preservation of the pelvic floor, preservation of the pericervical vascular and nerve tissue and especially, avoiding the danger zone of the uterine arteria and ureter, reduced physical stress, short hospitalisation and recovery time of the patients. 2. CISH via laparotomy: Prophylaxes against cervical cancer, preservation of the pelvic floor, reduction of the pelvic trauma, simple technique. 3. CISH via vagina: The advances of the intrafascial vaginal hysterectomy are the same as those for laparoscopic intrafascial hysterectomy without colpotomy, no separation of cardinalia and sacrouterina ligaments, no cervical amputation. No search for the uterine artery, no change in sexual life. Ideal conditions for the preservation of pelvic floor to regain stability. 4. During the resection of the transcervical and transuterine mucosa the technique of mucosa ablation emerged, indications are dysfunctional bleeding.