Minilaparotomy Hysterectomy as a Suitable Choice of Hysterectomy for Large Myoma Uteri: Literature Review

Abstract

The objective of this paper is to propose minilaparotomy hysterectomy as the suitable choice for large uterus on the basis of our experienced case of performed minilaparotomy hysterectomy to 4,500 g myoma uteri and review published cases about this clinical condition. We presented a 44-year-old woman (gravida 0, virgin) who consulted our hospital because of the chief complaints of abnormal genital bleeding and hypermenorrhea. Transabdominal ultrasonography revealed that abdominal solid tumor reached over the navel. Her tumor was an indication of surgery; to do minilaparotomy hysterectomy with laparoscope was decided because her informed consent was obtained. A 6 cm transverse incision (Maylard incision) was made to the skin above the pubic hairline. At the end of surgery, the length of abdominal wound was 8.5 cm, operating time was 128 min, weight of resected myoma uteri was 4,500 g, and intraoperative blood loss was 895 mL. Blood transfusion was not done; postsurgical course was not a problem without anemia. We propose that a large uterine case in which it is difficult to perform vaginal or laparoscopic hysterectomy should be considered in order to select minilaparotomy hysterectomy up to around 5 kg weight of uterus, and the length of skin incision in minilaparotomy hysterectomy is necessarily <9 cm particularly in large uterus.

A Mini-Laparotomy Hysterectomy for A Large Fibroid Uterus (>2850 Gm) Using A Modified “Paper Roll” Morcellation Technique - A Case Report

“…Thus we performed a minilaparotomy hysterectomy. To our knowledge, the weight of the heaviest uterus removed by minilaparotomy hysterectomy was 3250 g [5] However, the morcellation techniques used to remove large fibroid uterus in various reports had not been described in detail, and many were done via a piece by piece morcellation only [6]. In this paper, our purpose is to present a morcellation approach that will remove a large uterus in one piece (excluding the cervix) and allow the pathologist to easily reconstruct the uterus during the gross examination of the entire specimen to arrive at a precise pathology.…”

Feasibility and Compatibility of Minilaparotomy Hysterectomy in a Low-Resource Setting

“…It is being suggested that minilaparotomy is a minimally invasive procedure ideal for gynecologists who are less skilled in vaginal or laparoscopic surgery and who are more comfortable with the (standard) abdominal approach [ 7 ]. This approach is not only used for hysterectomy but also found to be the feasible option for myomectomies too [ 8 , 9 ], with a report of removal of myoma weighing 4.5 kg through the minilaparotomy technique [ 10 ].…”

Comment on “Minilaparotomy Hysterectomy as a Suitable Choice of Hysterectomy for Large Myoma Uteri: Literature Review”

“…We read with interest the article by Sato and Fukushima titled “Minilaparotomy Hysterectomy as a Suitable Choice of Hysterectomy for Large Myoma Uteri: Literature Review” [1]. Although this article does an excellent job in discussing benefit of the minilaparotomy approach to perform hysterectomy when laparoscopic or vaginal approach is hampered by the weight of the uterus, the study demonstrates that minilaparotomy should be considered as part of the minimally invasive armamentarium of surgical approaches for hysterectomy offered to patients with myomas.…”