Laparoscopic Versus Open Hysterectomy for Benign Disease in Women with Giant Uteri (≥1500 g): Feasibility and Outcomes

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

“…Notably, as well explained by Wu KY et al [9] and Yazucan et al [10], and also the case in our patient, the trocars positioning on the basis of the uterine size was the first and valued as the most important step affecting the laparoscopic surgery outcome, in addition to the choice of instruments and the experience and the harmony of the operating team [1, 11]. Furthermore, the techniques that we found helpful in completing the procedure through a minimally invasive approach were changing the trocars sites of the laparoscope throughout the procedure for better visualization (in fact, in the present case we started with the trocar positioned near the xiphoid process and then continued with umbilical access), and as specified by Yazucan et al [10] the ability to suspend from the pelvic floor the uterus through a skillful use of the uterine manipulator thus obtaining also both the best inspection of the ureter projections and a clear visualization of the vesico-uterine fold that aids to avoid potential bladder injury.…”

Laparoscopic Versus Open Hysterectomy for Benign Disease in Uteri Weighing >1 kg: A Retrospective Analysis on 258 Patients

“…This database is a research-quality institutional review board-approved data set that is prospectively maintained and regularly updated by trained residents and clinicians; it contains all the details and follow-up information concerning the surgical procedures performed at our department, including patients' characteristics, uterine weight, operative details, postoperative course, and complications. Some of the patients in the present series have been included in 2 previous publications by our group [7,8,10].…”

“…In these particular cases, there is not a univocal opinion on what should be the elective surgical approach. Until now, only a few studies have assessed this issue in a systematic way, and in all cases the main limitation was the relatively low number of patients included [8][9][10]. Of course, open abdominal surgery represents the most used approach in everyday clinical practice, but it must be noted that removing a very large uterus may be extremely difficult, irrespective of the surgical route.…”

“…The use of laparoscopy in case of uteri ≥1 kg has been described by pioneering reports that highlighted several difficulties, including problems in the mobilization of the uterus and poor visualization of the pelvic structures [8][9][10][11][12][13][14][15][16][17][18][19]. However, the growing experience in minimally invasive techniques has allowed us to accumulate surgical competence even in these challenging situations [7,8,10]. In 2013, we published a pilot case series on 71 laparoscopic hysterectomies for uteri ≥1 kg [8], reporting a low conversion rate and an acceptable profile of perioperative complications.…”

Patient Perceptions of Open, Laparoscopic, and Robotic Gynecological Surgeries

“…Minimally invasive surgery is the standard of care in the surgical management of many gynecologic conditions and is a modality commonly offered during treatment planning [1–5]. There are several readily available sources of information, such as brochures, pamphlets, and online resources, which can provide patients with basic information about minimally invasive options.…”