Laparoscopic Hysterectomy in Case of Uteri Weighing ≥1 Kilogram: A Series of 71 Cases and Review of the Literature

Trends in the Implementation of Advanced Minimally Invasive Gynecologic Surgical Procedures in The Netherlands

“…This is related especially to the enormous increase in the number of LHs performed, but a comparable trend is visible even for the less commonly performed myomectomy and lymphadenectomy procedures, demonstrating that laparoscopic surgery is being adapted in other fields of gynecologic surgery as well (e.g., fertility, oncology). Furthermore, an ongoing shift toward the laparoscopic approach can be expected, owing to the adoption of new technologies, increased surgical experience, and broader indications (e.g., oncology, performance of more complex procedures, removal of larger uteri) [12]. Moreover, the embedment of LH in residency programs has increased, with LH currently performed in all teaching hospitals and in 81% of nonteaching hospitals.…”

Total laparoscopic hysterectomy for large uterine cervical myoma

“…There are several previous reports on TLH for large myoma of the uterus (1–3); however, to the best of our knowledge, TLH for large cervical myoma has not been previously reported. Thus, this may be a useful report, despite the limited number of cases.…”

“…Regarding large myomas of the uterus, TLH is applicable even for uterine myomas weighing >1,000 g. It has been reported that the rate of switch to laparotomy was 4.2–9.7%, a small incision in the abdominal wall was necessary to extract the specimen in 21% of the cases, and the incidence of complications was 2.8–11.4% (3). Our department has performed TLH in 25 cases with a uterine weight of >500 g, with no reported ureteral damage or switch to laparotomy (data not shown).…”

“…Although a benign condition, surgery for large myoma of the uterus with extensive adhesions may be challenging, due to the high level of difficulty of the TLH procedure and difficulties with the identification of the uterine artery and ureter, which are mainly attributed to difficulty securing the visual field and operative space and poor uterine mobility (1–3). Among large myomas of the uterus, cervical myoma requires skilled techniques for dissecting the cervix, and surgery is considered the most difficult among TLH procedures for benign conditions.…”

Endoscopic Treatment and Power Morcellation of Uterine Fibroids

“…The authors identified six studies of laparoscopic hysterectomy for uteri weighing ≥1 kg for a total of 62 patients; conversion to open surgery was in 6 (9.7 %) patients, and additional 13 (21 %) received a minilaparotomic incision to extract the uterus. The overall complication rate reported in the literature was 11.4 % [98].…”