Laparoscopic hysterectomy for large uteri: Outcomes and techniques

Abstract

Laparoscopic hysterectomy is technically feasible and safe procedure for large uteri. The learning curve is about 50 cases and can be performed by experienced surgeons regardless of the size, number or location of the myomas without much morbidity.

Total Laparoscopic Hysterectomy Outcomes for Large Uterus (>14Weeks) Due to Large and Multiple Fibroids

“…13 Sinha et al reported the median operative time as 107 minutes in their TLH series for large uteri (mean size 17.5±2 weeks). 9 Similar to that Uccella et al reported 120 minutes of median operation time in large uteri weighing >1 kg. 8 Our results regarding operation time showed no significant difference between large uteri and controls.…”

“…Large uterus has been classified by uterine weight and/or size and various cut-off values have been identified. 3,8,9 Previous literature recommended TLH for uterus less than 15 weeks size or 500 g. 3 However, in a recent study Ucella et al defined large uterus as heavier than 1 kg. 8 In another one, Sinha et al defined as larger than 16 weeks size.…”

“…8 In another one, Sinha et al defined as larger than 16 weeks size. 9 With the passing of time the definition of large uterus has changed quickly due to increasing experience in endoscopic surgery. Few studies have investigated differences related to uterine weight between abdominal and laparoscopic surgeries.…”

Preclinical evaluation of a new robot-assisted surgical system for use in gynecology minimal access surgery

“…RALH was selected to be the main procedure for evaluation because hysterectomy is one of the most common gynecology surgeries performed and exemplifies the difficulties of achieving good access and challenging suturing of the vaginal cuff. Robotic assistance has been considered helpful in overcoming these issues [1,4,9,10].…”

“…This is due to certain limitations of conventional laparoscopy such as restricted movement, difficulty performing accurate suturing, uncomfortable positions for the surgeon and assistant, and twodimensional vision [1][2][3]8]. These limitations may contribute to the relatively low adoption of MAS for commonly performed gynecologic procedures, such as hysterectomy and sacrocolpopexy [4,[9][10][11].…”