Laparoscopic subtotal hysterectomy for large uteri using modified five port technique

Abstract

To evaluate outcome of laparoscopic subtotal hysterectomy (LASH) performed in women with large uteri using a modified five port technique. Prospective Cohort Study (Canadian Task Force classification III). Advanced laparoscopic Unit at the Whipps Cross University Hospital, London, UK. (1) All women with symptomatic and large uteri undergoing LASH, (2) previous three normal cervical smears and consent for future smears as protocol, (3) patient consent for the procedure. Prospectively collected database was analysed statistically for 29 women with enlarged uteri weighing more than 300 g who underwent LASH using the modified five port technique, during the time period of 24 months from Jan 2007 to Jan 2009. This technique demonstrates that the port placement facilitates the procedure. The mean age of the patients was 47 ± 4 years. Median BMI was 29 (range 22-41), Most common indication of surgery was menorrhagia in 90% of cases followed by palpable lump in 67% of cases. Median size of uterus was 18 weeks (range 12-30). Mean operative time was 84 ± 42 min. Median blood loss was 200 ml (range 100-800 ml).There was only one case with major complication such as bladder injury which was diagnosed and repaired intraoperatively. Mean hospital stay was 2 ± 1 day. None of the cases needed conversion to laparotomy. Modified five port technique of LASH for large uteri provides optimal exposure of the operative field to increase the efficiency and ease of the procedure and has its added cosmetic benefits.