Laparoscopically assisted hysterectomy for the large uterus

Objective To assess the results of performing laparoscopically assisted hysterectomy on uteri greater in size than 12 weeks. Design A prospective observational study. Setting South Cleveland Hospital, Middlesbrough, and St James' University Hospital, Leeds, UK. Subjects 21 consecutive women undergoing wholly laparoscopic or laparoscopically assisted total or subtotal hysterectomy with or without bilateral salpingo-oophorectomy. Main outcome measures These included uterine size and weight, techniques used to perform hysterectomy, surgical outcome, operative time, additional pathological conditions found, blood loss, intra- and postoperative complications and duration of hospitalization. Results Laparoscopically assisted hysterectomy was completed in all cases. The mean uterine weight was 522 g with a range of 390-785 g. The mean operating time was 144 min with a range of 78-330 min. Four of the patients had additional pathological conditions. None of the patients required a blood transfusion. Three patients suffered complications: a functional ileus, a small port-site haematoma and a ureteric injury. The mean hospital stay was 4.3 days (range 2-8 days). Conclusion Laparoscopic surgery can be used to avoid abdominal hysterectomy even with significant uterine enlargement, and allows the diagnosis and treatment of coexisting pelvic pathological conditions which cannot be adequately heated at vaginal hysterectomy. However the advantages must be weighed against the possible risk of increased complications.