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Updated: Aug 7, 2026
Laparoscopic Extracorporeal Knot-Tying for Uterine Vessel Occlusion during Hysterectomy with Cervical Cerclage in Large Uteri
Published on: September 12, 2025
The four-trocar method for performing laparoscopically-assisted vaginal hysterectomy on large uteri
Joong Sub Choi1, Young Soo Kyung, Kye Hyun Kim
1Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea. yjjy.choi@samsung.com
Study Objective:
To assess the feasibility and efficacy of laparoscopically-assisted-vaginal hysterectomy (LAVH) for a large uterus with the new trocar technique.
Design:
Retrospective clinical study (Canadian Task Force classification III).
Setting:
University teaching hospital.
Patients:
Thirty-four women with a large uterus (>500 g).
Intervention:
LAVH with Choi's 4-trocar method.
Measurements And Main Results:
We reviewed the medical records of 34 patients for age, parity, history of previous abdominal surgery, operative indications, histopathologic diagnosis, mean operative time, weight of the removed uterus, change in the hemoglobin level, hospital stay, and occurrence of any complications. The patient's median age was 45 years (range 36-51 years), median parity was 2 (range 0-3), and 18 patients (52.9%) had a previous operative history. The most common operative indication was a palpable abdominal mass, and the most common histopathologic diagnosis was leiomyoma. The median operative time was 62.5 minutes (range 35-245 minutes), and the median weight of the removed uterus was 615.0 g (range 500-1200 g). The median change in hemoglobin level was 1.4 g/dL (range 0-5 g/dL). The median hospital stay was 4.0 days (range 2-6 days). The only complication was superficial port site bleeding (1 patient). None of the operations were switched to total abdominal hysterectomy.
Conclusion:
Choi's 4-trocar method provided an excellent operative field during LAVH for a large uterus.
