Limits...
Total laparoscopic hysterectomy for large uterus.

Sinha R, Sundaram M, Lakhotia S, Mahajan C, Manaktala G, Shah P - J Gynecol Endosc Surg (2009)

Bottom Line: Average clinical size of the uterus was 18 weeks (10, 32).The average weight of the specimen was 700 grams (500, 2240).The average duration of surgery was 107 min (40, 300) and the average blood loss was 228 ml (10, 3200).

View Article: PubMed Central - PubMed

Affiliation: Beams Hospital, Mumbai - 400 052, India.

ABSTRACT

Aim: In this review, we assessed the feasibility of total laparoscopic hysterectomy (TLH) in cases of very large uteri weighing more than 500 grams. We have analyzed whether it is possible for an experienced laparoscopic surgeon to perform efficient total laparoscopic hysterectomy for large myomatous uteri regardless of the size, number and location of the myomas.

Design: Retrospective review (Canadian Task Force Classification II-1)

Setting: Dedicated high volume Gynecological laparoscopy centre.

Patients: 173 women with symptomatic myomas who underwent total laparoscopic hysterectomy at our center. There were no exclusion criteria based on the size number or location of myomas.

Intervention: TLH and modifications of performing the surgery by ligating the uterine arteries prior, myomectomy followed by hysterectomy, direct morcellation after uterine artery ligation.

Results: 72% of patients had previous normal vaginal delivery and 28% had previous cesarean section. Average clinical size of the uterus was 18 weeks (10, 32). The average weight of the specimen was 700 grams (500, 2240). The average duration of surgery was 107 min (40, 300) and the average blood loss was 228 ml (10, 3200).

Conclusion: Total laparoscopic hysterectomy is a technically feasible procedure. It can be performed by experienced surgeons for large uteri regardless of the size, number or location of the myomas.

No MeSH data available.


Related in: MedlinePlus

Morcellation while still attached
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Figure 8: Morcellation while still attached

Mentions: In large uteri, it may be difficult to debulk the uterus completely due to limitations in space and inaccessibility to uterosacrals. In such cases, we first do a supracervical hysterectomy after securing the uterine pedicles. Once the uterus is debulked, we go ahead and remove the cervix. In some cases we perform direct morcellation of the uterus after uterine artery ligation in order to debulk the specimen [Figure 8]. Once the bulk of the uterus has been morcellated, there is enough space for performing the final stages of the procedure, namely the desiccation and division of the uterosacral ligaments and colpotomy. The separated cervix is then delivered vaginally. Bleeding does not pose a problem as the ovarian and uterine vessels have been desiccated and cut. The vagina is closed with intracorporeal interrupted sutures with No 1 Vicryl.


Total laparoscopic hysterectomy for large uterus.

Sinha R, Sundaram M, Lakhotia S, Mahajan C, Manaktala G, Shah P - J Gynecol Endosc Surg (2009)

Morcellation while still attached
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3304266&req=5

Figure 8: Morcellation while still attached
Mentions: In large uteri, it may be difficult to debulk the uterus completely due to limitations in space and inaccessibility to uterosacrals. In such cases, we first do a supracervical hysterectomy after securing the uterine pedicles. Once the uterus is debulked, we go ahead and remove the cervix. In some cases we perform direct morcellation of the uterus after uterine artery ligation in order to debulk the specimen [Figure 8]. Once the bulk of the uterus has been morcellated, there is enough space for performing the final stages of the procedure, namely the desiccation and division of the uterosacral ligaments and colpotomy. The separated cervix is then delivered vaginally. Bleeding does not pose a problem as the ovarian and uterine vessels have been desiccated and cut. The vagina is closed with intracorporeal interrupted sutures with No 1 Vicryl.

Bottom Line: Average clinical size of the uterus was 18 weeks (10, 32).The average weight of the specimen was 700 grams (500, 2240).The average duration of surgery was 107 min (40, 300) and the average blood loss was 228 ml (10, 3200).

View Article: PubMed Central - PubMed

Affiliation: Beams Hospital, Mumbai - 400 052, India.

ABSTRACT

Aim: In this review, we assessed the feasibility of total laparoscopic hysterectomy (TLH) in cases of very large uteri weighing more than 500 grams. We have analyzed whether it is possible for an experienced laparoscopic surgeon to perform efficient total laparoscopic hysterectomy for large myomatous uteri regardless of the size, number and location of the myomas.

Design: Retrospective review (Canadian Task Force Classification II-1)

Setting: Dedicated high volume Gynecological laparoscopy centre.

Patients: 173 women with symptomatic myomas who underwent total laparoscopic hysterectomy at our center. There were no exclusion criteria based on the size number or location of myomas.

Intervention: TLH and modifications of performing the surgery by ligating the uterine arteries prior, myomectomy followed by hysterectomy, direct morcellation after uterine artery ligation.

Results: 72% of patients had previous normal vaginal delivery and 28% had previous cesarean section. Average clinical size of the uterus was 18 weeks (10, 32). The average weight of the specimen was 700 grams (500, 2240). The average duration of surgery was 107 min (40, 300) and the average blood loss was 228 ml (10, 3200).

Conclusion: Total laparoscopic hysterectomy is a technically feasible procedure. It can be performed by experienced surgeons for large uteri regardless of the size, number or location of the myomas.

No MeSH data available.


Related in: MedlinePlus