Feasibility and safety of total laparoscopic retrograde hysterectomy in a large uterus with obliterated cul-de-sac due to severe endometriosis

Abstract

ObjectiveTo examine the safety and feasibility of total laparoscopic retrograde hysterectomy (TLreH) in patients with obliterated cul-de-sac due to severe endometriosis. Study DesignThis retrospective case-control observational study was performed at the Yokohama Municipal Citizen’s Hospital between January 2014 and December 2019. Ninety-two women who underwent TLreH and who had uterine fibroids, adenomyosis, or both with obliterated cul-de-sac due to severe endometriosis were enrolled. ResultsSurgical outcomes were retrospectively analyzed. The median operation time was 122 (range, 54–312) min, and the median blood loss was 150 (range, 0–1420) mL. Perioperative complications (Clavien-Dindo classification ≥Ⅲ) occurred in 3 cases (3.3 %). There were no cases of transition to open surgery. Blood transfusion was required in 1 case. The operation time and estimated blood loss volume were significantly correlated with the weight of the uterus (p < 0.01). The subjects were divided into two groups: uteri weighing ≥600 g group and those weighing <600 g group. In the ≥600 g group, the median operation time and median estimated blood loss volume were 130 (81–312) min and 265 (70–1420) mL, respectively. There was no difference in the frequency of perioperative complications or blood transfusions between the groups. ConclusionOur study demonstrated that TLreH for severe endometriosis with obliterated cul-de-sac was feasible and safe. It could be safely performed for large uteri (≥600 g) with obliterated cul-de-sac due to severe endometriosis.