Minimally Invasive Hysterectomy for Uteri Greater Than 1 Kilogram [16Q

Abstract

INTRODUCTION: To assess the feasibility and safety of minimally invasive hysterectomy for uteri greater than 1 kilogram. METHODS: Between January 2009 and July 2015, a retrospective chart review was completed at our hospital for laparoscopic hysterectomy done for uteri weighing greater than one kilogram. RESULTS: From 2009 to 2015, 95 patients underwent minimally invasive hysterectomy with confirmed uterine weight over 1 kg. Eighty-eight percent were performed with traditional laparoscopy and 12% with robotic-assisted laparoscopy. The mean (SD) uterine weight was 1564 grams (637.5), the mean (SD) estimated blood loss was 334 mL (385.8), and mean (SD) operating time was 203 min (73.7). Five cases were converted to laparotomy (5.2%). Four cases converted secondary to hemorrhage and one converted due to extensive adhesive disease and inability to safely access the uterine artery. There were no conversions after 2011. In one case, damage to the serosa of the sigmoid colon during adhesiolysis was noted and repaired laparoscopically. Intra-operative transfusion was given in 8.4% of cases and post-operative transfusion in 5.2% of cases. However, after 2013, the rate of intra-operative transfusion decreased to 1.0% and post-operative transfusion to 2.1%. Of the 95 cases there were no cases of malignancy. CONCLUSION: To our knowledge, this provides the largest case series of hysterectomies over 1 kg completed by a minimally invasive approach. Our complication rate improved with experience and was comparable to other studies of laparoscopic hysterectomy for large uteri. When performed by experienced surgeons, minimally invasive hysterectomy for uteri greater than 1 kg can be considered feasible and safe.