Laparoscopic Hysterectomy for Uteri >250g: Analysis of Outcomes in a Single Surgery Center

Abstract

<h3>Study Objective</h3> There is conflicting data regarding the safety of hysterectomy performed on large uteri. This study aims to examine the outcomes of laparoscopic and robotic hysterectomies for large uteri in a referral tertiary academic center. <h3>Design</h3> This is a retrospective chart review study examining surgical characteristics and complications of laparoscopic/robotic hysterectomies performed for large uteri over a year-long period. <h3>Setting</h3> The setting for the study is tertiary academic institution. <h3>Patients or Participants</h3> A total of 67 laparoscopic/robotic hysterectomy cases with final pathological evaluation yielding a specimen weight of >250g were examined. <h3>Interventions</h3> The interventions for the study included laparoscopic/robotic hysterectomy. <h3>Measurements and Main Results</h3> All procedures were completed in a minimally invasive fashion. Patient characteristics included a median BMI of 31.8 (range 21-64). Average pre-operative uterine size was 16.5 weeks. The final specimen weight ranged from 255g to 2825g. The mean procedure time was 195 minutes (SD 69 minutes). Intraoperative complications included three serosal injuries and six vaginal/peroneal lacerations. In 76% of the cases, the uterine artery was ligated at the origin to minimize the blood loss. The estimated blood loss for surgery ranged from 25 to 600cc, with a median blood loss of 150cc. All the specimens were removed vaginally. Morcellation was completed in a contained fashion within a bag. The median post-operative stay in the hospital was 0 days (range 0-2 days). Post operatively, three patients had vaginal cuff dehiscence's with only one patient requiring readmission and reoperation. There were two admissions for post-operative small bowel obstruction vs ileus which were managed conservatively, and one readmission for post-operative pain. Final pathological evaluation of specimens showed leiomyomata in 91% of cases, adenomyosis in 51%, endometriosis in 18%, and malignancy in 1%. <h3>Conclusion</h3> The findings from this study add to existing data confirming that laparoscopic/robotic hysterectomy for large uteri is a feasible surgical approach without compromising patient safety or increasing surgical risks.