Abstract
Objective
The purpose of this study was to compare surgical outcomes following conventional
laparoscopic hysterectomy (LH) (C-LH) versus the combination method of LH plus laparoscopic
myomectomy (LM) (LH + LM) for the treatment of large uterine fibroids.
Study design
This study was performed in 56 patients (uterine weights ≥500 g) who underwent either C-LH or LH + LM performed by the same surgeon between May 2010 and May 2016. LH + LM was performed when C-LH was problematic because of poor visibility and/or mobility
due to uterine fibroids.
Results
The C-LH and LH + LM groups consisted of 27 (48%) and 29 (52%) patients, respectively. The clinical
characteristics of patients differed significantly only in the median sizes of the
dominant fibroid. The sizes of the dominant fibroid in the C-LH and LH + LM groups were 9.5 cm and 10.7 cm (P = 0.04), respectively. Regarding the surgical outcomes for the C-LH and LH + LM groups, the median uterine weights were 558 g and 737 g (P = 0.03), respectively, the median operating times were 156 min and 173 min (P = 0.23), respectively, and the median intraoperative blood losses were 150 g and 300 g (P = 0.0004), respectively. In all patients, LH was performed without conversion to laparotomy
and there were no cases of bladder, ureteral, or gastrointestinal tract injury. There
were no postoperative complications of Clavien-Dindo scale ≥ III in either group.
Conclusions
When C-LH cannot be performed because of large uterine fibroids that cause poor visibility
and/or mobility, LH + LM may allow the procedure to be successfully completed without conversion to laparotomy.
However, the latter approach increases the risk for intraoperative blood loss.
Keywords
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References
- Prospective randomized clinical trial of laparoscopically assisted vaginal hysterectomy versus total abdominal hysterectomy.Am J Obstet Gynecol. 1999; 180: 955-962
- Total laparoscopic hysterectomy compared with abdominal hysterectomy in the presence of a large uterus.J Am Assoc Gynecol Laparosc. 2002; 9: 333-338
- The evaluate study: two parallel randomised trials, one comparing laparoscopic with abdominal hysterectomy, the other comparing laparoscopic with vaginal hysterectomy.BMJ. 2004; 328: 129
- Laparoscopic hysterectomy.J Gynecol Surg. 1989; 5: 213-216
- Laparoscopically assisted hysterectomy for uteri weighing 500 g or more.J Am Assoc Gynecol Laparosc. 1994; 1: 405-409
- Laparoscopically assisted vaginal hysterectomy for large uterus: a comparative study.Eur J Obstet Gynecol Reprod Biol. 2004; 115: 219-223
- A simplified method to decrease operative blood loss in laparoscopic-assisted vaginal hysterectomy for the large uterus.J Am Assoc Gynecol Laparosc. 2004; 11: 370-373
- Laparoscopic-assisted vaginal hysterectomy with uterine artery ligation through retrograde umbilical ligament tracking.J Minim Invasive Gynecol. 2005; 12: 336-342
- The four-trocar method for performing laparoscopically-assisted vaginal hysterectomy on large uteri.J Minim Invasive Gynecol. 2006; 13: 276-280
- Total laparoscopic hysterectomy in cases of very large uteri: a retrospective comparative study.J Minim Invasive Gynecol. 2007; 14: 559-563
- Laparoscopic-assisted vaginal hysterectomy with in situ morcellation for large uteri.J Minim Invasive Gynecol. 2008; 15: 559-565
- Total laparoscopic hysterectomy for large uterus.J Gynecol Endosc Surg. 2009; 1: 34-39
- Experience with laparoscopic-assisted vaginal hysterectomy for the enlarged uterus.Arch Gynecol Obstet. 2009; 280: 425-430
- Surgical outcomes of laparoscopic hysterectomy for enlarged uteri.J Minim Invasive Gynecol. 2011; 18: 310-313
- Clinical relevance of conversion rate and its evaluation in laparoscopic hysterectomy.J Minim Invasive Gynecol. 2013; 20: 64-72
- Laparoscopic-assisted vaginal hysterectomy for uteri weighing 1000 grams or more.JSLS. 2008; 12: 376-379
- Total laparoscopic hysterectomy for uteri over one kilogram.JSLS. 2010; 14: 178-182
- Is laparoscopic hysterectomy feasible for uteri larger than 1000 g.Eur J Obstet Gynecol Reprod Biol. 2011; 158: 76-81
- Laparoscopic hysterectomy in case of uteri weighing ≥1 kilogram: a series of 71 cases and review of the literature.J Minim Invasive Gynecol. 2014; 21: 460-465
- Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.Ann Surg. 2004; 240: 205-213
- Laparoscopic excision of very large myomas.J Am Assoc Gynecol Laparosc. 2003; 10: 461-468
- Isobaric gasless laparoscopic myomectomy for removal of large uterine leiomyomas.Surg Endosc. 2006; 20: 1406-1409
- Simultaneous enucleation and in situ morcellation of myomas in laparoscopic myomectomy.Taiwan J Obstet Gynecol. 2010; 49: 279-284
- Application of simultaneous morcellation in situ in laparoscopic myomectomy of larger uterine leiomyomas.Med Princ Pract. 2011; 20: 455-458
Article info
Publication history
Published online: December 06, 2016
Accepted:
December 4,
2016
Received in revised form:
December 2,
2016
Received:
August 6,
2016
Identification
Copyright
© 2016 Elsevier Ireland Ltd. All rights reserved.
