Experience with laparoscopic-assisted vaginal hysterectomy for the enlarged uterus

The aim of this study is to evaluate the effect of uterine weight on the perioperative and postoperative outcomes of laparoscopically assisted vaginal hysterectomy (LAVH) for benign gynecological conditions.

In a retrospective observational study, 367 patients underwent LAVH (type I laparoscopic hysterectomy) for benign disorders at the Department of Gynecology at the Istanbul Bakirkoy Women and Children Hospital. Patients were divided into two groups with uterine weight <500 g and uterine weight > or =500 g. Outcome measures for both groups were studied comparatively in terms of length of operative time, pain score, amount of blood loss, requirement of blood transfusion, and length of hospital stay.

There were no differences in patients' mean age, parity, gravidity, rate of postmenopausal state, previous pelvic surgery, and body mass index. The most common indications for surgery were myoma and abnormal uterine bleeding. The duration of operation, estimated blood loss and requirement of blood transfusion were significantly less for <500 g group than for > or =500 g group. Three women in the <500 g group sustained a blood loss in excess of 500 ml. By comparison, 18 women in the > or =500 g group sustained a blood loss in excess of 500 ml (P = 0.000). Total complication rate was 8.7%. Postoperative ileus and febrile morbidity were the most common complications. No significant difference was noted in overall complications between groups (P = 0.13). During the vaginal part of the procedure bladder injury occurred in one patient who had uterine weight > or =500 g.

LAVH is a safe and efficient way to manage benign uterine disease and despite the increased operating time and blood loss, LAVH can be safely performed for enlarged uterus.