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Laparoscopic Extracorporeal Knot-Tying for Uterine Vessel Occlusion during Hysterectomy with Cervical Cerclage in Large Uteri
Published on: September 12, 2025
LAVH for large uteri by various strategies
Wen-Chun Chang1, Su-Cheng Huang, Bor-Ching Sheu
1Department of Obstetrics and Gynecology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
Acta Obstetricia Et Gynecologica Scandinavica
|May 1, 2008
Summary
Laparoscopically assisted vaginal hysterectomy (LAVH) is feasible for large uteri using specialized techniques. Experienced surgeons can achieve low complication and conversion rates, even for bulky uteri.
Area of Science:
- Gynecologic Surgery
- Minimally Invasive Procedures
- Uterine Pathology
Background:
- Laparoscopically assisted vaginal hysterectomy (LAVH) presents challenges with bulky uteri.
- Identifying specific problems and effective strategies for LAVH in heavy uteri is crucial.
Purpose of the Study:
- To investigate challenges associated with LAVH for bulky uteri.
- To evaluate strategies for overcoming difficulties in LAVH for uteri weighing 350-1,590 g.
Main Methods:
- Retrospective analysis of 181 women undergoing LAVH for myoma or adenomyosis (350-1,590 g).
- Implementation of key strategies: specialized trocar insertion sites, pre-ligation of uterine artery/adnexal collateral vessels, and laparoscopic/transvaginal volume reduction.
- Recording and analysis of clinical and operative parameters.
Main Results:
- Patients were categorized into medium (350-749 g, n=138) and large uteri (> or =750 g, n=43).
- Operative time and estimated blood loss significantly increased with uterine size (p<0.001).
- Large uteri group showed higher operative time (196+/-53 min), blood loss (234+/-200 ml), and bleeding/transfusion rates (14%/5%), all within acceptable ranges. Conversion to laparotomy was 2% for large uteri, 0.6% overall. No re-operations or mortality.
Conclusions:
- LAVH for large uteri is achievable with specialized surgical strategies.
- Experienced gynecologic surgeons can perform LAVH on most large uteri with minimal complications and low laparotomy conversion rates.
