A. Hysterectomy - Historical Perspective

The following is a chronologic historical perspective of significant events concerning hysterectomy:

SORANUS of Ephesus (2nd century AD)
First hysterectomy for prolapse, gangrenous uterus
Giaccorne BERENGARIO DaCapi (1480-1550)
First reference to altered sex life following vaginal hysterectomy for gangrenous uterus
Reported mortality rate 90%. Most doctors were of the opinion it was unlikely that one could survive a hysterectomy
RECAMIER (1774-1852)
1824: First successful vaginal hysterectomy for cancer of the cervix
SEMMELWEIS (1818-1865) and LISTER (1827-1912)
Antiseptic techniques reduced morbidity and mortality
SIMPSON (London, England)
1847: Introduction of chloroform anesthesia improved techniques for both abdominal and vaginal hysterectomy. However, chloroform was toxic, operations ideally were not supposed to exceed one hour. All techniques were designed out of necessity to be quick
HEATH (Manchester, England)
1843: First successful subtotal hysterectomy
15 cases of successful abdominal hysterectomy
PORO (Milan, Italy)
1876: First hysterectomy on gravid uterus
FREUND (Breslau, Germany)
30 Jan. 1878: First refined standardized reproducible "simple" abdominal hysterectomy
SCHAUTA and his student WERTHEIM (Vienna, Austria)
16 Nov.1898: First radical hysterectomy for cancer of the uterus

From 1900 to the 1940s in the United States subtotal hysterectomy was most often performed. The technique was considered simpler, safer, and associated with lower morbidity and less blood loss than total abdominal hysterectomy. During the 1940s and 1950s a great debate ensued at national and international meetings about the wisdom of removing the cervix at the time of hysterectomy as prophylaxis against cervical cancer. A number of studies reported an incidence of cervical stump cancer that ranged from 0.3% to as high as 10.7%.

PALMER (Paris, France)
1940s: Introduction of laparoscopy
1964: Proponents of subtotal hysterectomy. They tried to resolve the dilemma of cervical stump cancer by excising the cervical canal at supracervical hysterectomy, but the operation was fraught with complications
1961: had already recommended transvaginal electroconization of the cervix but had little success because of bleeding and infection
FRANGENHEIM (Konstanz, Germany)
1950s/1960s: Minimally invasive, organ preserving endoscopic surgery replaces laparotomy
SEMM (Kiel, Germany)
1970s/1980s: Marked advance with operative laparoscopy (pelviscopy)
REICH (Kingston, PA-USA)
1989: First laparoscopic-assisted vaginal hysterectomy
SEMM (Kiel, Germany)
7 Sept.1991: First C*I*S*H* (Classic Intrafascial S.E.M.M. Hysterectomy)
VIETZ and AHN (Westminster, MD-USA)
26 Dec.1991: First C*I*S*H* in the USA

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P.F.Vietz, M.D.
Westminster, MD 21157 (USA)

September 1997