Classical Intrafascial SEMM Hysterectomy

(CISH Procedure)

A Better Way to Have a Hysterectomy If You Really Need One!

First, a look at normal anatomy:

The above drawing shows the vagina, cervix (mouth of the womb), uterus and the tubes and ovaries.

If a woman needed a hysterectomy, it wasn't long ago that her only choices were either an abdominal or vaginal hysterectomy. This situation has changed dramatically within the past  ten years. Now, if a woman requires such surgery, she may choose a newer, safer, and better procedure. That procedure is known as a CISH Procedure. Dr. Zisow is one of only a handful of physicians trained and skilled in the performance of the CISH Procedure.

A little history is needed to better understand the above statements.  In the past, if a woman required a hysterectomy, a decision was made about what surgical procedure best served her needs. That decision depended upon the nature of her illness and on whether or not her uterus was anatomically well supported. A well supported uterus would be dealt with via an abdominal incision. Because of the nature of such incisions, the patient would require a minimum of six to eight weeks post operative recuperation time.

The red dotted line above represents the abdominal incision and the red arrows show the direction in which the surgery proceeds to ultimately remove the womb.  Notice that this involves entering the vagina to remove the cervix.  Once the uterus and cervix are removed the top of the vagina must be stitched closed for healing to occur.  This healing takes at least six weeks.

If, however, an element of uterine prolapse with associated vaginal support relaxation existed, then a vaginal hysterectomy would be considered.  However, even though there is no abdominal incision associated with a vaginal hysterectomy, a return to totally normal function (including sexual intercourse) usually took at least six weeks as well. This was due to the fact that the top of the vagina still had to be stitched closed and had to heal before normal activities could be resumed.

The 3 bold upward pointing arrows above indicate the vaginal approach to the surgery, cutting through the vagina and proceeding upward until the womb could be removed.  If a choice existed, the vaginal approach was always preferred because of the decreased discomfort afforded by the lack of a large abdominal incision.  Because of the diminished amount of pain involved with vaginal hysterectomy, doctors sought methods for doing more hysterectomies via the vaginal approach which otherwise would have to be done abdominally.  None the less, six or more weeks of healing were required before all normal activity could be resumed.

Laparoscopic Assisted Vaginal Hysterectomy (LAVH) was developed as the initial effort towards achieving the above goal. Utilizing several small abdominal incisions, laparoscopic instruments could be introduced into the abdomen to perform the "abdominal" portion of the hysterectomy and then a vaginal approach was taken to remove the uterus and cervix from the body.

It was the vaginal portion of the surgery that was the most difficult part of the LAVH procedure, and even when successful, at least six weeks of recuperation were still required to allow a complete return to all normal activities. 

If one could remove the uterus laparoscopically without having to disturb the vaginal tissues, then the best of both worlds could be attained. This is precisely what the CISH Procedure accomplishes.

As in the LAVH, several small abdominal incisions are utilized for the performance of the abdominal portion of the surgery. The difference between the procedures lies in how the vaginal aspects of the surgery are handled. 

Instead of removing the whole cervix, which necessitates cutting the vaginal walls around the cervix, only a central core of the cervix is removed. This allows the outer shell of the cervix to remain attached to the vagina.

Consequently, the support of the vagina is not disrupted and complete healing is much faster.  Usually women who experience the CISH Procedure are totally back to normal within three weeks of their surgery. One of Dr. Zisow's patients resumed playing soccer 2 1/2 weeks after her CISH Procedure. Needless to say, she was very pleased!

For more information about the CISH Procedure, please contact Dr. Zisow's office at 410-879-1010 for a free consultation appointment or e-mail questions directly to Dr. Zisow.  He will respond to you personally and privately.