Total Laparoscopic Hysterectomy of a 7400 g Uterus

Cesta, Megan; Kennedy, Bridget; Pasic, Resad

doi:10.1016/j.jmig.2020.06.019

Cited by 4 publications

(3 citation statements)

References 3 publications

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“…The first study on the ExCITE technique was conducted by Cesta et al [ 21 ] that reported a case of a woman who underwent laparoscopic total hysterectomy (with a uterus weighing 7400 g), bilateral salpingectomy and right ovariectomy. Following the ExCITE technique, the umbilical incision was enlarged up to 4 cm, and the surgical specimens were extracted using morcellation with a surgical scalpel.…”

Section: Discussionmentioning

confidence: 99%

C-section technique vs minilaparotomy after minimally invasive uterine surgery: a retrospective cohort study

Della Corte,

Guarino,

Vitale

et al. 2023

Arch Gynecol Obstet

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Purpose Uterine leiomyomas are benign uterine tumors. The choice of surgical treatment is guided by patient's age, desire to preserve fertility or avoid "radical" surgical interventions such as hysterectomy. In laparotomy, the issue of extracting the fibroid from the cavity does not arise. However, in laparoscopy and robotic surgery, this becomes a challenge. The aim of the present study was to determine the optimal surgical approach for fibroid extraction following laparoscopic or robotic myomectomy in terms of postoperative pain, extraction time, overall surgical time, scar size, and patient satisfaction. Methods A total of 51 patients met the inclusion criteria and were considered in our analysis: 33 patients who had undergone the "ExCITE technique" (Group A), and 18 patients a minilaparotomy procedure (Group B), after either simple myomectomy, multiple myomectomy, supracervical hysterectomy, or total hysterectomy. The diagnosis of myoma was histologically confirmed in all cases. Results Regarding the postoperative pain evaluation, at 6 h, patients reported 4 [3–4] vs 6 [5.3–7] on the VAS in Group A and B, as well as at 12 h, 2 [0–2] vs 3.5 [2.3–4] in Group A and B, respectively: both differences were statistically significant (p < 0.001). No statistically significant difference at 24 h from surgery was found. All patients in Group A were satisfied with the ExCITE technique, while in Group B only 67% of them. The length of the hospital stay was significantly shorter in Group A as compared to Group B (p = 0.007). In terms of the operative time for the extraction of the surgical specimen, overall operative time, and the scar size after the surgery, there was a statistically significant difference for those in Group A. Conclusion The ExCITE technique does not require specific training and allows the surgeon to offer a minimally invasive surgical option for patients, with also an aesthetic result. It is a safe and standardized approach that ensures tissue extraction without the need for mechanical morcellation.

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Section: Discussionmentioning

confidence: 99%

C-section technique vs minilaparotomy after minimally invasive uterine surgery: a retrospective cohort study

Della Corte,

Guarino,

Vitale

et al. 2023

Arch Gynecol Obstet

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“…To date, few studies tested the use of in-bag contained extracorporeal manual morcellation for large uteri after TLH, with the largest specimen weighing 1930 g[ 20 , 28 ]. In case of very large specimen, mostly single case reports, educational video articles and retrospective series with different technique and investigational devices have been reported[ 13 , 29 , 30 ]. To address these concerns, we developed an additional alternative technique of extracorporeal intrauterine morcellation carried out within the uterus utilizing its outer wall as a bag.…”

Section: Discussionmentioning

confidence: 99%

Novel technique of extracorporeal intrauterine morcellation after total laparoscopic hysterectomy: Three emblematic case reports

Macciò¹,

Sanna

Lavra

et al. 2021

WJCC

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BACKGROUND In the presence of a large uterus, total laparoscopic hysterectomy (TLH), always requires morcellation to allow removal of the tissues from the abdominal cavity. However, uncontained morcellation has been scrutinized because of the possible spread of occult leiomyosarcoma. Therefore, in-bag extracorporeal morcellation has been developed. However, tissue containment and extraction are extremely challenging, especially when considering the increasing uterine size to be removed through minimally invasive surgery. CASE SUMMARY Herein, we describe a novel technique for extracorporeal intrauterine morcellation using the uterus outermost layer as a bag to achieve tissue extraction of very large uteri with suspected occult leiomyosarcoma after TLH. The study enrolled patients who were planned for TLH for large uteri (weight > 500 g). TLH was performed following the procedure reported in our previous studies. The novel technique has been described step-by-step in a video, which representatively describes the preoperative imaging and morcellation procedure of three very large uteri weighing 1500 g, 1700 g, and 3700 g, respectively. The procedures were performed without any complications. The patients had an uneventful postoperative course, and in all cases, the pathology was benign leiomyoma. CONCLUSION Extracorporeal intrauterine morcellation using the uterus outmost layer as a bag was found to be a feasible technique that allows a careful diagnosis and safe removal of suspected occult malignancies. The technique herein presented may be adopted in surgical practice, by adding it to the other available techniques of contained morcellation. It may represent a valid and feasible alternative, especially useful in cases of very large uteri exceeding the capacity of specimen retrieval bags.

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“…Vaginal and abdominal hysterectomy has been complemented by laparoscopic procedures, such as vaginal hysterectomy assisted by laparoscopy, laparoscopic subtotal and total hysterectomy, and robotic hysterectomy. The implementation of new techniques was related to "new" complications, a series of studies comparing the alternative approaches for hysterectomy and an ongoing craftsmanship among gynecological surgeons about what is possible in laparoscopic surgery [1] [2] [3]. At the same time, a contrary movement dedicated to the preservation of the uterus emerged [4] [5] [6].…”

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confidence: 99%