본 중앙대학교 필동병원 산부인과학교실에서는 1993년 3월부터 1994년 9월까지 CISH 82예, TPH 37예, PAVH 91예를 경험하여 이에 대한 비교 분석을 시행하여 CISH수술의 장범들을 경험하엿다. 이 수술방법은 질 길이가 짧아지지 않으며, 경부주위 신경망의 파괴가 없고, 자궁천골-기인대(uterosacral-cardinal complex)가 보존되기 때문에 골반저부 지지력(pelvic floor support)의 감소가 적으며 골반경을 이용한 전자궁적출술에 비하여 수술중 골반장기 손상의 빈도가 적다는 사실을 경험하였다. 이에 문헌고찰과 함께 보고하는 바이다. 위에서 언급한 여러가지 장점들을 좀더 확실하게 규명하기 위해서는 오랜 동안의 추적관찰이 필요할 것으로 사료된다.

We conducted pelviscopic hysterectomy on 210 consecutive patients; 91 had laparoscopically (pleviscopically) assisted vaginal hysterectomy(LAVH/PAVH), 82 had classic intrafascial Semm hysterectomy(CISH), and 37 had Total pleviscoipic(laparoscopic) hysterectomy(TLH/ TPH) from March 1993 to September 1994. The groups were comparable with regard to age, parity, operation time, blood loss, weight of specimens, history of abdominal surgery, number of additional procedures performed, surgical indications, pathologic results; 31.4% had previous abdominal surgery, and 62.1% had additional procedures at hysterectomy. The mean estimated blood loss associated with PAVH was 1.6 times greater than that with CISH and 1.8 times greater than that with TPH. The length of surgery was influenced by patient selection, surgeon`s experiences, and equipment malfunction with a mean of 174.1 minutes for CISH, 164.9 minutes for TPH, and 142.5 minutes for PAVH. The mean specimen weight was 195.4gm for CISH(the greater among the three), 88.1gm for TPH and 142.5gm for PAVH. The EBL was meaningfully greatest in the PAVH. The mean hospital stay for CISH was 4.8 days and less than for TPH and PAVH. Pathologic results were greater for leiomyoma than other gynecological diseases in CISH and PAVH, but in TPH carcinoma in situ was greatest. The intraoperative and post operative complication rate was 3.7% in CISH, 5.4% in TPH and 7.7% in PAVH. But there were no major complications in CISH and only minor complications. We were able to perform the operations in the classic manners with grasping forceps, scissors, sultures and loops for CISH and TPH. We used Endo-GIAs in PAVH. The CISH, TPH and PAVH are appropriate operation for selected patients favorably comparing with standard abdominal or vaginal hysterectomy. There were no major complications such as bladder, ureter injuries and bowel injuries in the CISH. Pelvic floor support is maintained and sexual sensation may be less impaired in comparison with TPH and PAVH, CISH technique equates with minimally invasive and organ preserving surgery, also this may be sufficient for prevention of cervical cancer. This operations will be standard operation for hysterectomy in near future. But the procedures demand sophisticated instrumentation and a dedicated endoscopy team to ensure safe and efficient performance.