Minimally Invasive Hysterectomy for Uteri Greater Than One Kilogram

Abstract

Background and Objectives:To assess the feasibility and safety of minimally invasive hysterectomy for uteri >1 kg.Methods:Clinical and surgical characteristics were collected for patients in an academic tertiary care hospital. Included were patients who underwent minimally invasive hysterectomy by 1 of 3 fellowship-trained gynecologists from January 1, 2009, to July 1, 2015 and subsequently had confirmed uterine weights of 1 kg or greater on pathology report. Both robotic and conventional laparoscopic procedures were included.Results:During the study period, 95 patients underwent minimally invasive hysterectomy with confirmed uterine weight over 1 kg. Eighty-eight percent were performed with conventional laparoscopy and 12.6% with robot-assisted laparoscopy. The median weight (range) was 1326 g (range, 1000–4800). The median estimated blood loss was 200 mL (range, 50–2000), and median operating time was 191 minutes (range, 75–478). Five cases were converted to laparotomy (5.2%). Four cases were converted secondary to hemorrhage and one secondary to extensive adhesions. There were no conversions after 2011. Intraoperative transfusion was given in 6.3% of cases and postoperative transfusion in 6.3% of cases. However, after 2013, the rate of intraoperative transfusion decreased to 1.0% and postoperative transfusion to 2.1%. Of the 95 cases, there were no cases with malignancy.Conclusions:This provides the largest case series of hysterectomy over 1 kg completed by a minimally invasive approach. Our complication rate improved with experience and was comparable to other studies of minimally invasive hysterectomy for large uteri. When performed by experienced surgeons, minimally invasive hysterectomy for uteri >1 kg can be considered feasible and safe.

Laparoscopic Versus Open Hysterectomy for Benign Disease in Uteri Weighing >1 kg: A Retrospective Analysis on 258 Patients

“…It is reasonable to hypothesize that a center with a large number of such difficult cases may have a better experience and a lower need for conversion to open surgery. An indirect confirmation to this hypothesis is the fact that the second largest experience on laparoscopic management of uteri ≥1 kg reported a 5.2% conversion rate [33], which is similar to our findings.…”

Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy for uterus weighing ≥ 1kg

“…In our study, the mean uterus weight was 1141.8 g (range 1000-1720), which was kept in accordance with the publications of LH [4,9,[12][13][14]. In LH for large uterus, there were several cases which converted to AH, due to dense adhesions, narrow vaginal access, intraoperative hemorrhage, bulky myomas' location.…”

“…In our study, there were 3 (7.7%) women converted from an initially intended vNOTES to vaginal-assisted trans-umbilicus single-port laparoscopy, the major reason for conversion was being unable to posterior colpotomy; two of them had history of myomectomy, one of them was nulliparity. Even though the conversion rate (7.7%) was higher that of LH (5.2%) [14], we just converted vaginal-assisted transumbilicus single-port laparoscopy, which also belonged to minimally invasive approach. One of 39 procedures (2.6%) experienced intraoperative complication-right ureter injury, this was a nulliparity patient with endometriosis with adenomyoma, who was associated serious pelvic adhesion.…”

Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy for uterus weighing ≥ 1kg

“…In our study, there were 3 (7.7%) women converted from an initially intended vNOTES to vaginal-assisted trans-umbilicus single-port laparoscopy, the major reason for conversion was being unable to posterior colpotomy; two of them had history of myomectomy, one of them was nulliparity. Even though the conversion rate (7.7%) was higher that of LH (5.2%) [16], we just converted vaginal-assisted transumbilicus single-port laparoscopy, which also belonged to minimally invasive approach. One of 39 procedures (2.6%) experienced intraoperative complication-right ureter injury, this was a nulliparity patient with endometriosis with adenomyoma, who was associated serious pelvic adhesion.…”