Intrafascial vaginal hysterectomy (IVH): A new technique for minimally invasive surgery

Summary

Intrafascial vaginal hysterectomy (IVH) is a technique which was introduced by Semm in 1993. We conducted a retrospective chart review on the first 25 cases of IVH, performed in the Department of Obstetrics and Gynecology of the University of Kiel; these were carried out between June 1993 and January 1994. Using a cervix coring device, calibrated uterine resection tool (CURT), we aim to preserve the pelvic urodiaphragm structures, with particular regard to anatomical relations, blood supply and neural function. In this way full sexual function can be retained, and those patients who require a hysterectomy can have a better quality of life. The patients had an age range of 32–74 years with a mean of 47.4 years. The main indications for surgery presented were therapy-resistant uterine bleeding (56%) and myomas with menstrual abnormalities (52%). The mean estimated blood loss associated with IVH was 219.6 ml and the mean operative time was 84.4 min. There were three complications (12%), promptly identified and treated without further problems. Histological studies on the cored-out cervix specimens showed only three cases (12%) demonstrating glands reaching the edge. With this minimally invasive technique we observed several advantages to the patient, achieved without any added difficulties to the surgical procedure itself.

Key Words:

• intrafascial vaginal hysterectomy
• minimally invasive surgery
• laparoscopically assisted vaginal hysterectomy