2932 Total Laparoscopic Hysterectomy: 5 Step Approach for Uteri Larger than 500 Grams

Abstract

Video Objective To demonstrate a five step approach facilitating successful completion of Total Laparoscopic Hysterectomy (TLH) in patients with uteri larger than 500 grams. Setting Tertiary health care facility. Two consecutive patients underwent TLH for fibroid uterus, abnormal uterine bleeding and pelvic pain. Interventions Total Laparoscopic Hysterectomy, Bilateral Salpingectomy (BS) and Cystourethroscopy. Two consecutive patients with large uteri who failed medical management and desired definitive surgical management were selected. Both patients diagnosed with multiple uterine leiomyomas and underwent pre-operative endometrial biopsy and magnetic resonance imaging to minimize risk of occult malignancy. Patient one had a uterus measuring 22 × 15 × 12 cm and patient two had a uterus measuring 20 × 16 × 13 cm. They both had history of multiple prior abdominal surgeries. The mean total operative time was 78 minutes and EBL was 50 ml in both cases. They were discharged on postoperative day one and had no complications. Conclusion TLH is a feasible option for women with a uterus larger than 500 grams. Despite the uterine size and multiple prior abdominal surgeries, a systematic approach to performing TLH allows safe completion of surgery with relatively short surgical time and minimal blood loss while affording the recognized benefits of minimally invasive surgery.