2003 Association of Pre-Operative Uterine Dimensions and Success of Contained Morcellation Following Minimally Invasive Hysterectomy

Abstract

Study Objective To determine if uterine dimensions on pre-operative imaging are associated with success of contained morcellation during minimally invasive hysterectomy. Design Canadian Task Force Classification Level of Evidence II-2 Setting Surgical patients in a single metropolitan academic institution. Patients or Participants Patients undergoing laparoscopic or robotic hysterectomy and requiring morcellation for specimen extraction from March 2017 through April 2019 Interventions At the completion of surgery, a contained extraction system was inserted, and the specimen was placed within the bag. Manual morcellation was performed vaginally, abdominally, or via a combination of both methods in cases of failed vaginal extraction. Morcellation times were recorded. Medical records were reviewed to abstract demographic and clinical data. Measurements and Main Results A total of 39 patients were treated. Median age was 47 (range 25 – 70) and mean length of stay was 0.74 days. There were no conversions to laparotomy, readmissions, or surgical site infections within 30 days after surgery. Morcellation was performed vaginally for 24 patients (61.5%), abdominally for 10 patients (25.6%), and via combined approach for 5 patients (12.8%). Largest uterine dimension on imaging was median 12.6 centimeters (range 6 – 19.7) in the vaginal group, 11.9 (7.2 – 20) in the abdominal group, and 16.4 (14.1 – 23) in the combined group (p=0.046). Both morcellation time (mean 19.7 minutes vaginal, 38.9 abdominal, 78.6 combined; p Conclusion Larger uterine dimensions are associated with failed vaginal extraction, and pre-operative imaging can assist with surgical decision-making. Providers need to be deliberate when choosing route of specimen removal, as morcellation and total operating time significantly increase when vaginal morcellation is unsuccessful.