CISH ( Classic Intrafascial SEMM Hysterectomy ) for Huge Uterine Leiomyomata

Kim, Dong Ho; Kang, Byung Hee; Kim, Sung Ho

Abstract

Since hysterectomy using laparoscopy has been first reported in 1989, various techniques for laparoscopic hysterectomy were developed. However, complications during hysterectomy still remained and many clinicians assert that huge uterine masses should be performed with laparotomy for safety. We have performed CISH for benign uterine disease such as uterine leiomyomata, PID, chronic pelvic pain, DUB and adenomyosis, etc since 1993. This report is to evalute the clinical efficacy and the feasibility of the CISH for huge uterine masses, which include 20 patients who underwent CISH with huge uterine leiomyomata(more than 250 gm and /or 14 gestational size) between June 1995 and May 1996 in Chung-Ang University Pil-Dong Hospital. No laser, monopolar and stapling cutting devices were used. All of the hysterectomy procedures were performed in the classic manner with grasping forceps, scissors, ligatures, and sutures. We excluded the patients who had cervical neoplasia, or who wanted to have total removal of the uterus in this study. The results were as follows. 1) The age of patients were ranged from 37 to 50 years, and the mean age was 43.78+/-3.8 years. 2) The parity distribution of patients were ranged from 0 to 4, the mean was 1.93+/-0.9. 3) The mean operative time was 171.78+/-36.5minutes, ranged from 130 to 240 minutes. 4) The mean estimated blood loss(EBL) was 223.8+/-206.7cc, ranged from 40 to 700cc 5) The mean uterine weight was 345.9+/-87.3gm, ranged from 256 to 625.7gm 6) There was no major complications and a few minor complication. No procedure was converted to laparotomy. This report suggests that the CISH technique for benign huge uterine leiomyomata is feasible, safer technique, and associated with significantly low morbidity and no major complication.