CISH advocated for women with benign disease.(Gynecology)

NEW YORK -- Classic intrafascial supracervical hysterectomy should be considered the procedure of choice when hysterectomy is indicated for benign disease, John E. Morrison Jr., M.D., said at an international congress of the Society of Laparoendoscopic Surgeons.

Like standard supracervical hysterectomy, the CISH technique leaves intact the cardinal ligaments, uterosacral ligaments, vascular supply, and innervation to the upper vaginal vault and cervix. However, unlike the standard technique, CISH also involves removal of the transition zone and the endocervical canal.

"The procedure has all the advantages of a supracervical hysterectomy--retention of the pelvic floor support, innervation, and blood supply--with removal of the potentially dangerous tissue," Dr. Morrison, a general surgeon at Fayette Medical Center, Fayette, Ala., told this newspaper.

Indications for CISH are the same as for standard hysterectomy. The procedure is not appropriate for women with carcinoma or any contraindication to laparoscopy.

The procedure involves a modified supracervical hysterectomy with mobilization of the round, broad ligaments to the uterine artery trunk, where the dissection stops. The uterosacral and cardinal ligaments are maintained, with the blood supply and the innervation left intact. The uterine body is removed with the endometrial cavity, followed by the transition zone and the endocervical canal.

To avoid the uterine artery/ureter junction, he noted, it's critical to elevate the uterine body out of the pelvis and to stop the dissection before the uterine artery trunk. Use of a 30- or 45-degree scope allows superior visualization of the pelvic structure.

Dr. Morrison's experience with 652 patients between November 1992 and July 2004 in a rural community setting suggest that CISH is safe and has a short recuperation period with high patient satisfaction. The average patient age was 45.2 years, ranging from 22 to 92 years, and the ...