A Laparoscopic Assisted Minilaparotomy Hysterectomy approach for Very Large Fibroid Uteri of more than 1000 grams – A Preliminary Study

Abstract

Objective: To report the surgical outcome of a laparoscopic assisted minilaparotomy hysterectomy (LMH) surgical approach for the management of very large fibroid uteri. [5][6][7][8][9]. However, this minilaparotomy approach might still be considered difficult for the very large fibroid uteri because of the difficulty to assess the sizes and locations of fibroids, presence of adhesions and the iceberg phenomenon of the large fibroid uterus within the pelvis. Introduction A Laparoscopic Assisted Minilaparotomy Hysterectomy approach for Very Large Fibroid Uteri of more than 1000 grams -A PreliminaryOn the other hands, some laparoscopists would also find hysterectomy for very large fibroid uteri difficult to perform. The laparoscopic hysterectomy for large fibroid is known to be difficult surgeries with long operating time, increased blood loss sometimes requiring blood transfusion or conversions to open laparotomy [10][11][12].Setting: A private hospital, St. Paul's Hospital, in Hong Kong Patients and Surgical techniques:It is a retrospective study to assess a hysterectomy approach for very large fibroid uteri of more than 1000 grams. This paper described the surgical technique of this hysterectomy approach and presented the patient characteristics, surgical data and clinical outcome.Result: From 2011 to 2014, 13 women underwent a surgical approach of laparoscopic assisted minilaparotomy hysterectomy with or without salpingo-oophorectomy (LMH +/-SO) for very large fibroid uteri larger than 1000 grams. All hysterectomies were successfully completed without intraoperative or postoperative complication. The amount of blood loss was comparatively less than that of abdominal hysterectomy for very large fibroid uteri reported in the literature. All patients recovered well after operation and many had an early discharge from hospital. Conclusion:In conclusion, this surgical approach for hysterectomy can replace open abdominal hysterectomy for very large fibroid uteri more than 1000 grams. The technique is a combination of laparoscopy and minilaparotomy hysterectomy. It is a safe and feasible alternative as a minimally invasive surgery for very large fibroid uteri.