Prediction of Need for Morcellation during Total Laparoscopic Hysterectomy

Abstract

Study Objective With all the concerns surrounding uterine morcellation, our objective was to identify predictors of the need for morcellation during total laparoscopic hysterectomy (TLH). Design A retrospective cohort study (Canadian Task Force classification II-2). Setting University Hospital Center. Patients or Participants Women undergoing a TLH for a benign gynecologic pathology form January 1st 2017 to January 31th 2019. Interventions All women underwent a TLH. If the uterus was to voluminous to be removed vaginally, surgeons favored in-bag morcellation by laparoscopy. Uterine weight (uterine length x maximum width x anteroposterior diameter x 0.52) and characteristics (number and volume of leiomyomas) were assessed prior to surgery by ultrasound or MRI in order to predict the need for morcellation. Measurements and Main Results A total of 252 women underwent a TLH during the two-year period. Women had a mean age of 46±7 (30–71) years old and the three main indications for surgery were abnormal uterine bleeding (77%), chronic pelvic pain (36%) and bulk symptoms (25%). Mean uterine weight was 325 (17-1572)±272 grams, with 11/252 (4%) uterus being >1000 grams and 71% of women had at least one leiomyoma. Among women with a uterine weight 500 grams, 49 (100%) required morcellation. In addition to the estimated uterine weight (≥ 250 versus Conclusion Uterine weight estimated by preoperative imaging as well as the size and number of leiomyomas are useful predictors of the need for morcellation.