A randomized trial of intrastromal abdominal hysterectomy to support shorter hospital stay, prevent blood loss, and preserve pelvic support

Advantages of nerve-sparing intrastromal total abdominal hysterectomy

“…Furthermore, using this procedure, the outer stroma of the cervix is the pericervical ring, and the cervix is removed from this bed. This should also be helpful in preventing future cervical cancer 3,9,22…”

“…The other two patients remained incontinent due to intrinsic sphincter deficiency, as verified by history, physical examination, and urodynamic testing. ISTAH-BSO has shown the capability to correct stress urinary incontinence in patients, because it preserves nerve fibers and the support system following removal of the uterus 9,12,23,24. Furthermore, ISTAH-BSO keeps the endopelvic fascia intact.…”

“…Inclusion criteria included both medically and surgically stable patients presenting with symptoms that, in the opinion of the gynecologist and patient, justified hysterectomy. Indications for hysterectomy were intramural or submucosal uterine leiomyoma, anemia, chronic menorrhagia, chronic metrorrhagia, amenorrhea, and pelvic endometriosis 5,9. Written informed consent was obtained from all women who agreed to participate in the study and to attend a follow-up visit one year later.…”

“…Outcomes in the study group were compared with outcomes in a control group of 20 patients who had undergone conventional abdominal hysterectomy procedures performed by the same surgeon at Fountain Valley Regional Hospital 1,9,10. The study protocol was approved by the Central Investigational Review Board.…”

“…Using a thermo-electric or laser knife, a circumferential incision is made just cephalad to the pericervical ring and stroma at the level of the ligated uterine arteries, below the internal os or isthmus (Figure 1 and Figure 2). 9–13 The incision must be performed by cutting and sometimes coagulation in the case of bleeding. The pericervical ring and peripheral portion of the cervix must be protected (Figure 2).…”