Extraperitoneal Laparoscopic Hysterectomy for Fibroid Uteri

The feasibility of dividing the uterine arteries laparoscopically using the extraperitoneal technique for laparoscopic hysterectomy to remove large (>e;500 g) fibroid uteri was assessed in a retrospective review. Over 9 months, 24 women underwent extraperitoneal laparoscopic hysterectomy for a fibroid uterus. Additional procedures were performed in five patients: one colposuspension, one pelvic lymphadenectomy, and three pelvic and aortic lymphadenectomies. In 14 cases the uterus weighed 500 g or more (mean 847 g), 5 weighed 0.7 to 1.0 kg, and 3 weighed 1 kg or more. One patient had pelvic and another had pelvic plus aortic lymphadenectomy in addition to hysterectomy. Two (14%) women required transfusion. Twenty-five (89%) of 28 uterine arteries were divided laparoscopically; both arteries in 12 patients, one artery in 1 patient, and neither artery in 1. None of the women in whom both uterine arteries were divided required transfusion, whereas both in whom one or both arteries were divided vaginally did. In most patients undergoing a laparoscopic hysterectomy by the extraperitoneal technique, both uterine arteries can be divided laparoscopically, and the procedure seems to reduce blood loss.