Laparoscopic Hysterectomy: Impact of Uterine Size

O’Hanlan, Katherine A.; McCutcheon, Stacey Paris; McCutcheon, John G.

doi:10.1016/j.jmig.2010.09.016

Cited by 56 publications

(42 citation statements)

References 12 publications

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“…In considering studies on laparoscopic hysterectomy for large uteri reporting that increased uterine size is associated with an increase of procedure time [4, 7, 8], our case had an acceptable operative time. Noteworthy, in the present case the timing spent for the hysterectomy was limited, whilst the greatest time was dedicated to the extraction of the huge uterus that required also a lot of attention in performing morcellation, avoiding spillage; then, it was the extraction that influenced significantly the time of the entire operation.…”

Section: Discussionmentioning

confidence: 90%

Laparoscopic removal of a very large uterus weighting 5320 g is feasible and safe: a case report

et al. 2017

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BackgroundTotal laparoscopic hysterectomy (TLH) has demonstrated to be feasible and safe in the presence of very large uteri. However, it is currently difficult to establish the upper uterine weight limit for successful performance of a laparoscopic hysterectomy.Case presentationHere we report the case of a TLH performed for a very large fibromatous uteri weighing 5320 g in a 40-year-old Caucasian woman. The surgery had no complications with an operating time of approximately 220 min. The patient was discharged from the hospital on postoperative day 3 in very good condition. To our knowledge, the present paper is the only to describe a uterus of this size removed by laparoscopic hysterectomy.ConclusionsOur case demonstrates that uterine size is not a determinant for a final surgical decision to use laparoscopic hysterectomy. Therefore, if not contraindicated by the patient’s comorbidities or peculiar anatomical conditions, we believe that laparoscopic hysterectomy could be performed in the presence of large uteri without hypothetical weight limits.

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Section: Discussionmentioning

confidence: 90%

Laparoscopic removal of a very large uterus weighting 5320 g is feasible and safe: a case report

et al. 2017

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“…The surgeon typically inserts the urethral catheter after draping, then inserts a uterine manipulator and may need to subsequently maneuver it during the course of the surgery. The surgeon may need to morcellate a large uterus through the vagina [10] or perform cystosufflation [8] or laparoscopic cystoscopy [9], both of which require manipulation of the urethral catheter, and then suture the vagina laparoscopically. Traditionally, surgeons have avoided contact with the vaginal field or changed their gloves and even re-gowned after every contact, under the assumption that the perineal and vaginal fields are not sterile [3].…”

Section: Discussionmentioning

confidence: 99%

“…By the time of colpotomy, the solution is absent. In reliance on this combined-field, thorough scrub, preparation, and dwell technique, the surgeon inserts and may repeatedly maneuver the uterine manipulator, the urethral catheter [8], performs a vaginal morcellation, uses the 5-mm laparoscope for cystoscopy, and immediately reuses it in the abdominal field [9] without re-gowning or changing gloves [10]. However, any incidental contact with the anus during the procedure would require a change of glove.…”

Section: Operative Techniquementioning

confidence: 99%

Single-Field Sterile Scrub, Preparation, and Dwell for Laparoscopic Hysterectomy

O’Hanlan

McCutcheon

et al. 2012

Journal of Minimally Invasive Gynecology

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“…Some bulky uteri can reach massive proportions and can significantly distort the pelvic anatomy. They may have extensive vascular supplies and compromise the operative field, which not only increases the difficulty of hysterectomy, but also the risks of operative complications [6,7]. Moreover, because of inherited pitfalls of SPA surgery such as in-line viewing, lack of triangulation, and instrument crowding [8], SPA-TLH for a large uterus is considered to be a very difficult operation.…”

Section: Introductionmentioning

confidence: 99%

Single-Port Access Total Laparoscopic Hysterectomy for Large Uterus

Song

Lee

Kim

et al. 2012

Gynecol Obstet Invest

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Background/Aims: To evaluate the feasibility and safety of single-port access total laparoscopic hysterectomy (SPA-TLH) for large uterus (>500 g). Methods: A prospective data collection was performed in 21 consecutive patients in March 2010 and August 2011. Surgical outcome including operative time (OT) and estimated blood loss (EBL) were analyzed. Results: SPA-TLH procedures were successfully performed in 16 cases (76.2%). Of the 5 failed cases, 4 were converted to multiport TLH because of distorted uterine contours and pelvic adhesions and 1 was converted to laparotomy for bleeding control. The median OT, uterine weight, and EBL were 110 (65–165) min, 600 (502–980) g, and 200 (100–800) ml, respectively. Spearman’s correlation analysis demonstrated that OT and blood loss increased with increasing uterine weight (p = 0.003 and p = 0.033, respectively). No operative complications were observed during the hospital stay and 3-month follow-up following discharge. Conclusion: SPA-TLH for large uterus is a feasible and safe technique.

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Laparoscopic Hysterectomy: Impact of Uterine Size

Cited by 56 publications

References 12 publications

Laparoscopic removal of a very large uterus weighting 5320 g is feasible and safe: a case report

Laparoscopic removal of a very large uterus weighting 5320 g is feasible and safe: a case report

Single-Field Sterile Scrub, Preparation, and Dwell for Laparoscopic Hysterectomy

Single-Port Access Total Laparoscopic Hysterectomy for Large Uterus

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