Total laparoscopic hysterectomy for large uterus.

Area of Science:

• Gynecological Surgery
• Minimally Invasive Procedures
• Reproductive Health

Background:

• Uterine fibroids are common, often leading to symptomatic conditions requiring hysterectomy.
• Large uteri present surgical challenges for traditional and minimally invasive hysterectomy.
• Total laparoscopic hysterectomy (TLH) offers potential benefits but its feasibility for very large uteri is debated.

Purpose of the Study:

• To assess the feasibility of performing total laparoscopic hysterectomy (TLH) for uteri weighing over 500 grams.
• To evaluate the efficacy of TLH in cases of large myomatous uteri, irrespective of fibroid size, number, or location.
• To determine if experienced laparoscopic surgeons can efficiently manage large uteri via TLH.

Main Methods:

• Retrospective review of 173 women undergoing TLH at a high-volume gynecological laparoscopy center.
• No exclusion criteria based on uterine size, myoma characteristics, or location.
• Surgical modifications included pre-ligation of uterine arteries, myomectomy followed by hysterectomy, and direct morcellation.

Main Results:

• The average uterine specimen weight was 700 grams (range: 500-2240 grams).
• Average surgical duration was 107 minutes (range: 40-300 minutes) with an average blood loss of 228 ml (range: 10-3200 ml).
• 72% of patients had prior normal vaginal delivery, and 28% had prior cesarean sections.

Conclusions:

• Total laparoscopic hysterectomy is a technically feasible procedure for large uteri.
• Experienced surgeons can successfully perform TLH on large myomatous uteri regardless of fibroid complexity.
• TLH is a viable option for managing symptomatic large fibroids, offering a minimally invasive approach.