Objective: This study was conducted to analyze whether preoperative magnetic resonance imaging (MRI) can be used as a predictor of difficult total laparoscopic hysterectomy.
Methods: The medical records of 107 patients who underwent total laparoscopic hysterectomy from August 2013 through December 2014 were examined. MRI was performed before operation. Data on uterine weight, surgery time, and blood loss were extracted from the medical charts of all patients. Using MRI, we measured the maximum longitudinal diameter, maximum anteroposterior diameter in the sagittal section, and maximum transverse diameter in the transverse section of each uterus. The approximate ellipsoid volume was estimated from MRI parameters. A correlation coefficient was calculated for the correlation between approximate ellipsoid volume and weight of the removed uterus. The patients were divided into two groups based on operative time (120 minutes) and blood loss (100 mL). We employed a receiver operating characteristic (ROC) curve analysis to determine the best cut-off point to predict difficult total laparoscopic hysterectomy.
Results: The average uterine weight was 326±196 g; operative time, 155±53 minutes; blood loss, 164±274 mL; and approximate ellipsoid volume, 380±225 cm3. As a result of the regression analysis, the regression equation Y (uterine weight) = 0.628X (approximate ellipsoid volume) + 116.4 (R = 0.746, P < 0.0001) was obtained. A strong correlation was observed between maximum transverse diameter and operative time and blood loss. The cut-off value in the ROC curve showed a tendency toward increased operative time and blood loss for a transverse diameter >81 mm and >70 mm, respectively.
Conclusion: The results showed that MRI is a useful preoperative indicator of the uterine weight. Preoperative MRI should be used as a screening procedure as it is a good predictor of difficult total laparoscopic hysterectomy. Our data suggest that total laparoscopic hysterectomy is difficult when removing a large uterus, having the greatest transverse diameter of more than 70 mm.
