The Intrafascial Technique for Total Abdominal Hysterectomy: Revisiting the Valuable Classic Procedure

Background: Total abdominal hysterectomy (TAH) is frequently performed for benign gynecologic conditions with the presence of a large distorted uterus and/or severe extrauterine diseases such as pelvic endometriosis or adhesion. Operative injury to adjacent organs is a major concern. Performing the procedure by using intrafascial approach has many potential benefits in preventing complications. Objective: The aim of this research was to illustrate the intrafascial technique for TAH as performed at the Faculty of Medicine, Chiang Mai University, in Chang Mai, Thailand, and to describe clinical and operative outcomes of patients with benign gynecologic conditions who underwent TAH including this technique. Materials and Methods: For this study, retrospective reviews were performed, using clinical, operative, and pathologic data from all patients who underwent TAH with the intrafascial technique for benign gynecologic conditions from January 2003 to December 2012. Descriptive statistics were used to elucidate the surgical outcomes. Results: The intrafascial technique was used in 161 patients undergoing TAH. Approximately 40% of the patients had severe pelvic pathology. All procedures were accomplished without injuries to surrounding organs. The rate of operative complications was low. Conclusions: The intrafascial technique for TAH is a simple procedure that provides many benefits including low risk of injury to surrounding structures, a well-supported vaginal vault, obliteration of dead space, and effective hemostasis. However, the procedure has been largely neglected by the gynecologic community. For modern gynecologists to be able to perform safe abdominal hysterectomy, knowledge of this intrafascial technique is crucial. (J GYNECOL SURG 31:11)