Laparoscopic-assisted vaginal hysterectomy for uteri weighing 1000 grams or more.

Laparoscopic-assisted vaginal hysterectomy for uteri weighing 1000 grams or more.

Fanning James; Fenton Bradford; Switzer Michella; Johnson Jil; Clemons Jessica

JSLS : Journal of the Society of Laparoendoscopic Surgeons

2008

2008-12

INTRODUCTION: Prospective randomized trials have proven the benefits of laparoscopic-assisted vaginal hysterectomy (LAVH) compared with abdominal hysterectomy. The purpose of this study was to evaluate the safety and efficacy of LAVH performed for uteri weighing \textgreater or =1000 grams. METHODS: Fifteen patients underwent attempted LAVH for uteri \textgreater1000g. Median age was 45 years old (range, 31 to 57), and median weight was 170 pounds (range, 130 to 236); 64% had medical comorbidities, and 43% had prior pelvic surgery. Five ports (5 mm) were used to allow maximum uterine manipulation. Uterine vessels were doubly coagulated. RESULTS: Fourteen of 15 cases (93%) were successfully completed laparoscopically. Median uterine weight was 1090 grams (range, 1000 to 1650). Median operative time was 3.5 hours (range, 2 to 4.6), and median blood loss was 400 mL (range, 100 to 1200). All patients were discharged on postoperative day one, and no patients developed a postoperative complication. CONCLUSION: We believe that LAVH is a safe and effective approach for uteri larger than 1000 g. It is our opinion that 3 surgical techniques are required; maximum Trendelenburg position, adequate number of ports, and double coagulations of the uterine vessels.

Adult; Female; Humans; Middle Aged; Laparoscopy/*methods; Hysterectomy; Leiomyoma/surgery; Organ Size; Uterine Neoplasms/surgery; Uterus/*pathology; Vaginal/*methods

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376–379

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