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Updated: Jul 2, 2026
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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
Assessing Perioperative Risk According to Surgical Route in Hysterectomy for Very Large Uteri
Alison C Fitzgerald1, Parmida Maghsoudlou1, Shabnam Gupta2
1Brigham and Women's Hospital, Boston, Massachusetts, USA. (Drs. Fitzgerald, Maghsoudlou, King, Einarsson, and Ajao).
Summary
Laparoscopic hysterectomy is a safe and feasible option for enlarged uteri over 1kg. While operative time is longer, it does not increase complications, offering shorter hospital stays.
Area of Science:
- Gynecology
- Minimally Invasive Surgery
- Surgical Outcomes
Background:
- Minimally invasive hysterectomy offers benefits but poses challenges for enlarged uteri.
- Laparoscopic hysterectomy is technically demanding in patients with large uteri ( > 1kg).
Purpose of the Study:
- To compare surgical outcomes of laparoscopic versus open hysterectomy in patients with large uteri (> 1kg).
Main Methods:
- Retrospective cohort study at a tertiary-care academic center.
- Included patients undergoing laparoscopic or open hysterectomy for benign indications (2009-2024).
- Primary outcome: composite measure of complications, readmissions, and reoperations.
Main Results:
- 509 patients: 268 laparotomy, 241 laparoscopy.
- Similar risk of complications, readmissions, or reoperations between groups (OR 1.09 [0.68-1.77]).
- Laparoscopy group had lower blood loss (100 vs 300 mL), longer operative time (188 vs 164 min), and shorter hospital stay (0 vs 2 days).
Conclusions:
- Laparoscopic hysterectomy is feasible for uteri exceeding 1kg.
- Increased operative time in laparoscopy did not correlate with increased perioperative complications.
