Laparoscopically assisted hysterectomy for uteri weighing 500 g or more

We attempted to determine the feasibility and results of laparoscopically assisted vaginal hysterectomy (LAVH) for removing symptomatic fibroid uteri not suitable for vaginal hysterectomy. We retrospectively reviewed cases in which the uterus weighed 500 g or more and was considered not suitable for traditional vaginal hysterectomy after examination under anesthesia. Laparoscopically assisted hysterectomy with or without unilateral or bilateral adnexectomy was successfully completed in 20 (91%) of 22 cases. Thirteen patients had concurrent laparoscopic lysis of adhesions, and one a laparoscopic bladder neck suspension. Mean uterine weight was 837 g, mean operating time 167 +/- 42 minutes, mean blood loss 390 +/- 107 ml, and mean hospital stay 2.6 days. No febrile morbidity or surgical complications occurred among these patients. The only significant intraoperative complication was bleeding requiring blood transfusions, which occurred in one of the two women who required abdominal hysterectomy. Our results suggest that LAVH is a safe and effective alternative to total abdominal hysterectomy of the very large fibroid uterus, and that conversion to total abdominal hysterectomy could be expected to occur in less than 10% of cases.