[Hysterectomy via laparotomy or pelviscopy. A new CASH method without colpotomy]

Abstract

Total Hysterectomy has been until non performed by extracervical "enucleation" of the fascia of the uterine corpus with amputation of the vagina. The new method leaves the extrafascial highly vascularised vascular stem, the corresponding nerves and the topography of the ureter untouched. It is limited to an intrafascial cylindriform enucleation of the cervix. The diameter of the cervical cylinder can be determined beforehand by vaginal sonography. Punching-out is effected from a new instrument C.U.R.T. (= calibrated uterine resection tool) of 10-20 mm diameter. A cervicohaemostaser provides for safe transvaginal haemostasis in the residual cervix. The transvaginal sexual sensations of the patient are not impaired due to the fact that the cardinal ligaments are preserved as well as the nerve supply of the cervical fascia. Suspension of the cervical fascia at the supporting ligaments of the uterus can be performed in an ideal manner. Pelviscopic extirpation of the uterus is done in the classical way used in abdominal hysterectomy with ligature and suture. Morcellated cylinders of 2-3 cms in diameter, of the cervix and corpus uteri and even of myomas up to the size of a child's head, will suffice for relevant histological examination. The physical stress to which the patient is exposed is about the same as in routine surgical pelviscopy. The abdominal space remains practically unopened in pelviscopic transabdominal hysterectomy. Pelviscopic transabdominal hysterectomy with and without adnexae according to the CASH technique corresponds to surgery performed with a minimum of invasiveness. It is fully sufficient as regards cancer prophylaxis with respect to cervical or endometrial cancer.