E-ISSN: 2619-9467

Contents    Cover    Publication Date: 23 Oct 2019
Year 2019 - Volume 29 - Issue 3

Open Access

Peer Reviewed

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Total Laparoscopic Hysterectomy Outcomes for Large Uterus (>14Weeks) Due to Large and Multiple Fibroids

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J Clin Obstet Gynecol. 2019;29(3):110-5
DOI: 10.5336/jcog.2019-70932
Article Language: EN
Copyright Ⓒ 2020 by Türkiye Klinikleri. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)
Objective: Total laparoscopic hysterectomy (TLH) seems to be the best surgical route for most cases. However, the technical difficulties, while removing a large uterus due to huge fibroids should be noted. The aim of this study was to assess the effect of large uterine size (>14 weeks) due to large fibroids on the outcome of TLH. Material and Methods: A total of 234 TLH cases were included in the study. The study group consisted of the patients with clinical size >14 gestational weeks uterus (n=99). The control group consisted of patients with smaller uterine size and operated with benign indications (n=135). The groups were comparable regarding body mass index, comorbidities, and previous abdominal surgery. Results: The mean duration of operation, estimated blood loss and the rates of complications were similar between the groups. The rate of conversion to laparotomy did not show a statistically significant difference between the groups. There were five conversions in the study group due to excessive bleeding (n=2), inability to mobilize the uterus (n=2), and intestinal injury (n=1). The two conversions in the control group were also due to excessive bleeding. Conclusion: Total laparoscopic hysterectomy for large uterine size >14 weeks size due to large fibroids seems to be a safe and successful surgical approach.
  1. Jacoby VL, Autry A, Jacobson G, Domush R, Nakagawa S, Jacoby A. Nationwide use of laparoscopic hysterectomy compared with abdominal and vaginal approaches. Obstet Gynecol. 2009;114(5):1041-8. [Crossref] [PubMed] [PMC]
  2. Ceccaroni M, Roviglione G, Pesci A, Quintana S, Bruni F, Clarizia R. Total laparoscopic hysterectomy of very enlarged uterus (3030 g): case report and review of the literature. Wideochir Inne Tech Maloinwazyjine. 2014;9(2):302-7. [Crossref] [PubMed] [PMC]
  3. Kluivers KB, Hendricks JC, Mol BW, Bongers MY, Bremer GL, de Vet HC, et al. Quality of life and surgical outcome after total laparoscopic hysterectomy versus total abdominal hysterectomy for benign disease: a randomized, controlled trial. J Minim Invasive Gynecol. 2007;14(2):145-52. [Crossref] [PubMed]
  4. Kondo W, Bourdel N, Marengo F, Botchorishvili R, Pouly JL, Jardon K, et al. Is laparoscopic hysterectomy feasible for uteri larger than 1000 g? Eur J Obstet Gynecol Reprod Biol. 2011;158(1):76-81. [Crossref] [PubMed]
  5. Harb TS, Adam RA. Predicting uterine weight before hysterectomy: ultrasound measurements versus clinical assessment. Am J Obstet Gynecol. 2005;193(6):2122-5. [Crossref] [PubMed]
  6. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187-96. [Crossref] [PubMed]
  7. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205-13. [Crossref] [PubMed] [PMC]
  8. Uccella S, Morosi C, Marconi N, Arrigo A, Gisone B, Casarin J, et al. Laparoscopic versus open hysterectomy for benign disease in uteri weighing >1 kg: a retrospective analysis on 258 patients. J Minim Invasive Gynecol. 2018;25(1):62-9. [Crossref] [PubMed]
  9. Sinha R, Swarnasree G, Rupa B, Madhumathi S. Laparoscopic hysterectomy for large uteri: outcomes and techniques. J Minim Access Surg. 2019;15(1):8-13. [Crossref] [PubMed] [PMC]
  10. Ark C, Güngördük K, Celebi I, Celikkol O. Experience with laparoscopic-assisted vaginal hysterectomy for the enlarged uterus. Arch Gynecol Obstet. 2009;280(3):425-30. [Crossref] [PubMed]
  11. Terzi H, Hasdemir PS, Biler A, Kale A, Sendag F. Evaluation of the surgical outcome and complications of total laparoscopic hysterectomy in patients with enlarged uteruses. Int J Surg. 2016;36(Pt A):90-5. [Crossref] [PubMed]
  12. Nakayama K, Tsukao M, Ishikawa M, Ishibashi T, Nakamura K, Sanuki K, et al. Total laparoscopic hysterectomy for large uterine cervical myoma. Mol Clin Oncol. 2017;6(5):655-60. [Crossref] [PubMed] [PMC]
  13. Wattiez A, Soriano D, Fiaccamento A, Canis M, Botchorishvill R, Pouly J, et al. Total laparoscopic hysterectomy for very enlarged uteri. J Am Assoc Gynecol Laparosc. 2002;9(2):125-30. [Crossref]
  14. O'Hanlan KA, Dibble SL, Garnier AC, Reuland ML. Total laparoscopic hysterectomy: technique and complications of 830 cases. JSLS. 2007;11(1):45-53.
  15. Schöller D, Taran FA, Wallwiener M, Schönfisch B, Kramer B, Abele H, et al. Laparoscopic supracervical hysterectomy and laparoscopic total hysterectomy in patients with very large uteri: a retrospective single- center experience at a major university hospital. Geburtshilfe Frauenheilkd. 2017;77(3):251-6. [Crossref] [PubMed] [PMC]
  16. Kehde BH, van Herendael BJ, Tas B, Jain D, Helsen K, Jochems L. Large uterus: what is the limit for a laparoscopic approach? Autops Case Rep. 2016;6(1):51-6. [Crossref] [PubMed] [PMC]
  17. Wu KY, Lertvikool S, Huang KG, Su H, Yen CF, Lee CL. Laparoscopic hysterectomies for large uteri. Taiwan J Obstet Gynecol. 2011;50(4):411-4. [Crossref] [PubMed]