Laparoscopic-Assisted Vaginal Hysterectomy with In Situ Morcellation for Large Uteri
Journal
Journal of Minimally Invasive Gynecology
Journal Volume
15
Journal Issue
5
Pages
559-565
Date Issued
2008
Author(s)
Abstract
Study Objective: To estimate whether laparoscopic in situ morcellation (LISM) can facilitate laparoscopic-assisted vaginal hysterectomy (LAVH) for large uteri. Design: Prospective study (Canadian Task Force classification II-1). Setting: University-affiliated hospital. Patients: In all, 147 women with myoma or adenomyosis weighing more than 500 g from January 2004 through December 2007 were enrolled. The patients were divided into 4 subgroups: patients with uteri weighing 500 to 749 g who had traditional LAVH without LISM (group 1A, n = 69) or with LISM (group 1B, n = 16); and patients with uteri weighing 750 g or more who were treated by traditional LAVH without LISM (group 2A, n = 38) or with LISM (group 2B, n = 24). Interventions: Laparoscopic-assisted vaginal hysterectomy with or without LISM. Measurement and Main Results: No significant differences existed in age, body mass index, preoperative diagnoses, complications, or duration of hospital stay among groups. The mean uterine weights were 608 ± 75, 597 ± 66, 989 ± 179, and 935 ± 226 g for groups 1A, 1B, 2A, and 2B, respectively. The operative time (120 ± 16 vs 157 ± 36 minutes, p <.001; 140 ± 19 vs 224 ± 57 minutes, p <.001) were significantly shorter in patients with LISM than without in both groups 1 and 2. The estimated blood loss was highest in group 2A. Six (16%) patients lost more than 500 mL of blood and 3 (8%) of them needed blood transfusions. Conversion to laparotomy occurred in 1 (2.6%) of 38 patients in group 2A. No repeated surgery or surgical mortality occurred. Conclusion: Laparoscopic-assisted vaginal hysterectomy with LISM was an efficient and safe procedure for removal of large uteri during LAVH. ? 2008 AAGL.
SDGs
Other Subjects
adenomyosis; adult; article; bleeding; blood transfusion; body mass; body weight; female; human; laparoscopic surgery; laparotomy; length of stay; major clinical study; morcellation; myoma; operation duration; prospective study; uterus surgery; uterus weight; vaginal hysterectomy; Adenomyoma; Adult; Blood Loss, Surgical; Case-Control Studies; Female; Humans; Hysterectomy, Vaginal; Laparoscopy; Leiomyomatosis; Middle Aged; Organ Size; Uterine Neoplasms; Uterus
Type
journal article