Laparoscopic supracervical hysterectomy for the larger uterus (>500g): a case series and literature review.

Abstract

In clinical practice, the current trend for surgical hysterectomy for the large uterus is by laparotomy, where vaginal hysterectomy is not feasible. The benefits of a laparoscopic approach to hysterectomy are well documented, but limited literature is available on laparoscopic hysterectomy in the larger uterus. A supracervical hysterectomy should be considered for women, where there is no contraindication to a residual cervix. To compare surgical outcomes for laparoscopic supracervical hysterectomy (LSH) in the large uterus (equal or greater than 500g) compared with normal (<500g), results were compared to the limited literature on this topic. A retrospective review was undertaken of 207 women who underwent an LSH between 2005 and 2015 at Whipps Cross University hospital. The operative outcome of patients undergoing surgery, for uteri both greater than 500g and less than 500g, was analysed. Data included patient demographics, intra-operative details, and complications. A literature search was performed using keywords 'laparoscopic supracervical hysterectomy' and 'laparoscopic sub-total hysterectomy' which yielded six informative articles. In the study group of 207 patients, 67 had a large uterus (56 patients 500-1000g, 11 patients >1000g). The operation time and intra-operative blood loss were both greater in the larger uterus cohort (P<0.0001 and P=0.0021, respectively). The hospital stay and intra-operative complication rate were similar for the two study cohorts (six for the study, n=207). Review of the literature revealed six relevant studies evaluating patients with uteri greater than 500g. There was an agreement between all the studies that a larger uterus resulted in an increase in both intra-operative time and blood loss, but this did not translate to increase in hospital stay or intra-operative complications. The use of LSH for the larger uterus is feasible and safe due to the low level of operative complications as demonstrated in our study and following a review of the literature.