Abstract
Objective: To investigate the feasibility of a total laparoscopic hysterectomy (TLH) for large uteri weighting over 500 g.
Design: Retrospective analysis.
Setting: Department of Obstetrics and Gynecology, Fukui Red Cross Hospital, Japan.
Patients: A total of 156 women who underwent a TLH from 2009 through 2014 for symptomatic uterine leiomyomas and/or adenomyosis at our institution were divided into two groups based on uterine weight: > 500 g (Group A; n = 32) and < 500 g (Group B; n = 124). Outcome measures were evaluated by comparison of the two groups in regard to patient characteristics, surgical outcomes, rates of conversion to laparotomy, and complications.
Results: Intraoperative blood loss and surgery time were significantly greater in Group A than Group B (blood loss: 325 ± 550 ml vs. 123 ± 175 ml; surgery time: 246 ± 50 min vs. 183 ± 44 min; P < 0.05). Rate of conversion to laparotomy was significantly higher in group A than Group B (9.4% vs. 0.8%; P < 0.05). There were no significant differences in the incidence of total postoperative complications (9.4% vs. 5.6%) or major postoperative complications that required further treatment (3.1% vs. 3.2%).
Conclusions: Despite the increased intraoperative blood loss, surgery time, and rate of conversion to laparotomy, a TLH for a large uterus (> 500 g) can be performed without an increased risk of post-operative complications. However, surgeons have to be proficient with specific surgical approaches for a large uterus and be aware of the potential risk of conversion to laparotomy.
