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Re: Supracervical HysterectomyFrom: Obsteve@aol.comTue Oct 31 19:19:28 1995
Gordon, I have participated in about 15 CISH cases so far (as both primary surgeon and first assistant). I think that relatively few patients are good candidates for the procedure but the ones that are, do remarkably well. I agree with your comments re coring of the cervix and I don`t think that the data is there yet to suggest that this will prevent later dysplastic or malignant change. We`ve all seen recurrent dysplasia at a cone site! To me it seems that one reason to core is possibly to eliminate any functioning endometrium that you might have missed by amputating the fundus too high although electrocautery of the canal would probably be just as effective. We have seen zero morbidity from the coring and it is remarkably hemostatic. The biggest technical challenge that we have had so far is getting the endoloops over a large uterus (even when we have made our own large loops). I think the CISH procedure has great promise in cases where a TVH would be very difficult or where an LAVH would likewise be very tough also. The extra effort and time involved in a CISH seems to be well worth it when you see the patient the next day and they`re smiling and anxious to leave the hospital. I`d be interested to hear from anyone else doing this procedure as to their operative experiences to date. Steve Straubing M.D. Cincinnati, Oh ObSteve@AOL.com
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