Hand-Assisted Total Laparoscopic Hysterectomy of a 5200-Gram Uterus

Abstract

Introduction: Hysterectomy is one of the most common gynecologic procedures performed. Minimally invasive laparoscopic techniques are preferred; however, laparotomy is still commonly performed for large uteri.Case Description: We performed hand-assisted total laparoscopic hysterectomy of a 5200-g uterus.Discussion: Hand-assisted laparoscopy is an alternative approach to laparotomy for large uteri and has similar benefits to traditional laparoscopic surgery. To our knowledge, the uterus in our patient is the largest uterus reported to have been removed laparoscopically.

Trocar Configuration in laparoscopic hysterectomy for benign indications

“…The operative time was 150 min, blood loss of 220 ml and discharged home on the second postoperative day without complications. Hand-assisted laparoscopic hysterectomy has been described successfully in a case of a fibroid uterus weighing 5020 g without complications;[ 27 ] The authors used a 5-mm left upper quadrant trocar, a 10-mm trocar below the xiphoid in the midline, two further 5-mm trocars (one in the left and one in the right upper quadrant) and a 7-cm vertical midline laparotomy (2 cm above the pubic symphysis), through which a GelPort ® Laparoscopic System (Applied Medical, Rancho Santa Margarita, CA) was inserted. They used a 45° laparoscope, the operation lasted 315 min and blood loss was 120 ml.…”