Autopsy and Case Reports
http://autopsyandcasereports.org/article/doi/10.4322/acr.2016.025
Autopsy and Case Reports
Article / Clinical Case Report

Large uterus: what is the limit for a laparoscopic approach?

Beatriz H. Kehde, Bruno J. van Herendael, Benedictus Tas, Deepika Jain, Karine Helsen, Lisbeth Jochems

Downloads: 38
Views: 1039

Abstract

Hysterectomy is the most common surgical gynecologic procedure, which is frequently related to the treatment of leiomyoma. The laparoscopic hysterectomy is associated with a shorter hospital stay, fewer infection rates, and a faster return to daily activities. Most gynecologists do not recommend a hysterectomy via the vagina or a laparoscopic-assisted vaginal hysterectomy (LAVH) in the case of a uterus weighing more than 300 g. This case report presents the case of an LAVH undertaken in a 43-year-old patient with a uterus weighing 2,800 g. There are no definite guidelines concerning the procedure for a large uterus, and the literature is vague regarding the best surgical procedure for these cases. The size of the uterus does not seem to be an absolute contraindication for endoscopic surgery. This procedure relies entirely on the surgeon’s ability.

Keywords

Hysterectomy, Vaginal, Uterus, Leiomyoma

References

1. Whiteman MK, Hillis SD, Jamieson DJ,  et al. Inpatient hysterectomy surveillance in the United States, 2000- 2004. Am J Obstet Gynecol. 2008;198(1):34.e1-7. http://dx.doi.org/10.1016/j.ajog.2007.05.039. PMid:17981254.

2. Farquhar CM, Steiner CA. Hysterectomy rates in United States 1990-1997. Obstet Gynecol. 2002;99(2):229-34. http://dx.doi.org/10.1016/S0029-7844(01)01723-9. PMid:11814502.

3. Cramer SF, Patel A. The frequency of uterine leiomyomas. Am J Clin Pathol. 1990;94(4):435-8. PMid:2220671.

4. Wu JM, Wechter ME, Geller EJ, Nguyen TV, Visco AG. Hysterectomy rates in the United States, 2003. Am J Obstet Gynecol. 2007;110(5):1091-5. http://dx.doi.org/10.1097/01.AOG.0000285997.38553.4b. PMid:17978124.

5. Nieboer TE, Johnson N, Lethaby A, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2009;(3):CD003677. PMid:19588344.

6. Johnson N, Barlow D, Lethaby A, Tavender E, Curr E, Garry R. Surgical approach to hysterectomy for benign gyneacological disease. Cochrane Database Syst Rev. 2006;2(2):CD003677. PMid:16625589.

7. Wattiez A, Soriano D, Fiaccavento A,  et al. Total laparoscopic hysterectomy for very enlarged uteri. J Am Assoc Gynecol Laparosc. 2002;9(2):125-30. http://dx.doi.org/10.1016/S1074-3804(05)60119-3. PMid:11960035.

8. Reich H, DeCaprio J, McGLYNN FRAN. Laparoscopic hysterectomy. J Gynecol Surg. 1989;5(2):213-6. http://dx.doi.org/10.1089/gyn.1989.5.213.

9. Olsson JH, Ellstrom M, Hahlin M. A randomized prospective trial comparing laparoscopic and abdominal hysterectomy. Br J Obstet Gynaecol. 1996;103(4):345-50. http://dx.doi.org/10.1111/j.1471-0528.1996.tb09740.x. PMid:8605132.

10.Wong WS, Lee TC, Lim CE. Novel vaginal “paper roll” uterine morcellation technique for removal of large (>500g) uterus. J Minim Invasive Gynecol. 2010;17(3):374-8. http://dx.doi.org/10.1016/j.jmig.2010.02.005. PMid:20417430.

11.Kondo W, Bourdel N, Marengo F, et al. Is laparoscopic hysterectomy feasible for uteri larger than 1000g? Eur J Obstet Gynecol Reprod Biol. 2011;158(1):76-81. http://dx.doi.org/10.1016/j.ejogrb.2011.03.027. PMid:21555178.

12.Walid MS, Heaton RL. Laparoscopic extirpation of a 3kg uterus. Arch Gynecol Obstet. 2009;279(4):607-8. http://dx.doi.org/10.1007/s00404-008-0827-9. PMid:19011884.

13.Uccella S, Cromi A, Bogani G, Casarin J, Formenti G, Ghezzi F. Systematic implementation of laparoscopic hysterectomy independent of uterus size: clinical effect. J Minim Invasive Gynecol. 2013;20(4):505-16. http://dx.doi.org/10.1016/j.jmig.2013.02.009. PMid:23870240.

14.Chen SY, Chang DY, Sheu BC,  et al. Laparoscopic assisted vaginal hysterectomy with in situ morcellation for large uteri. J Minim Invasive Gynecol. 2008;15(5):559-65. http://dx.doi.org/10.1016/j.jmig.2008.06.002. PMid:18657481.

15.Alperin M, Kivnick S, Poon KY. Outpatient laparoscopic hysterectomy for large uteri. J Minim Invasive Gynecol. 2012;19(6):689-94. http://dx.doi.org/10.1016/j.jmig.2012.06.007. PMid:23084671.

16.Walid MS, Heaton RL. Total laparoscopic hysterectomy for uteri over one kilogram. JSLS. 2010;14(2):178-82. http://dx.doi.org/10.4293/108680810X12785289143837. PMid:20932364. 17.Sahin Y. Vaginal hysterectomy and oophorectomy in women with 12-20 weeks’ size uterus. Acta Obstet Gynecol Scand. 2007;86(11):1359-69. http://dx.doi.org/10.1080/00016340701657258. PMid:17963064.

18.Ghezzi F, Raio L, Mueller MD, Gyr T, Buttarelli M, Franchi M. Vaginal extraction of pelvic masses following operative laparoscopy. Surg Endosc. 2014;16(12):1691-6. http://dx.doi.org/10.1007/s00464-002-9043-z. PMid:12140631. 19.Lin YS. New helical incision for removal of large uteri during laparoscopic assisted vaginal hysterectomy. J Am Assoc Gynecol Laparosc. 2004;11(4):519-24. http://dx.doi.org/10.1016/S1074-3804(05)60086-2. PMid:15701196.

20.Srouji SS, Kaser DJ, Gargiulo AR. Techniques for contained morcellation in gynecologic surgery. Fertil Steril. 2015;103(4):e34. http://dx.doi.org/10.1016/j.fertnstert.2015.01.022. PMid:25712576.

21.Walid MS, Heaton RL. Use of bowel bags in gynecologic laparoscopy. Arch Gynecol Obstet. 2009;279(5):777-9. http://dx.doi.org/10.1007/s00404-008-0923-x. PMid:19151992.

22.Nimaroff ML, Dimino M, Maloney S. Laparoscopic- assisted vaginal hysterectomy of large myomatous uteri with supracervical amputation followed by trachelectomy. J Am Assoc Gynecol Laparosc. 1996;3(4):585-7. http://dx.doi.org/10.1016/S1074-3804(05)80171-9. PMid:9050693.

23.Uccella S, Cromi A, Serati M, Casarin J, Sturla D, Ghezzi F. Laparoscopic hysterectomy in case of uteri weighting >1kg: a series of cases and rewiew of the literature. J Minim Invasive Gynecol. 2014;21(3):460-5. http://dx.doi.org/10.1016/j.jmig.2013.08.706. PMid:24012921.

24.Shin JW, Lee HH, Lee SP, Park CY. Total laparoscopic hysterectomy and laparoscopy-assisted vaginal hysterectomy. JSLS. 2011;15(2):218-21. http://dx.doi.org/10.4293/108680811X13071180406394. PMid:21902979.

25.Drahonovsky J, Haakova L, Otcenasek M, Krofta L, Kucera E, Feyereisl J. A prospective randomized comparison of vaginal hysterectomy, laparoscopically assisted vaginal hysterectomy, and total laparoscopic hysterectomy in women with benign uterine disease. Eur J Obstet Gynecol Reprod Biol. 2010;148(2):172-6. http://dx.doi.org/10.1016/j.ejogrb.2009.10.019. PMid:19926201.

26.Chou LY, Sheu BC, Chang DY,  et al. Operating time and blood loss during laparoscopic-assisted vaginal hysterectomy with in situ morcellation. Acta Obstet Gynecol Scand. 2011;90(9):985-9. http://dx.doi.org/10.1111/j.1600-0412.2011.01196.x. PMid:21615713.

27.Uccella S, Ceccaroni M, Cromi A,  et al. Vaginal cuff dehiscense in a series of 12,398 hysterectomies: effect of different types of colpotomy and vaginal closure. Obstet Gynecol. 2012;120(3):516-23. http://dx.doi.org/10.1097/AOG.0b013e318264f848. PMid:22914459.

28.Kadar N, Reich H, Liu CY, Manko GF, Gimpelson R. Incisional hernias after major laparoscopic gynaecologic procedures. Am J Obstet Gynecol. 1993;168(5):1493-1495. http://dx.doi.org/10.1016/S0002-9378(11)90787-X. PMid:8498433.

29.Walid MS, Heaton RL. Laparoscopic extirpation of a 3-Kg uterus. Arch Gynecol Obstet. 2009;279(4):607-8. http://dx.doi.org/10.1007/s00404-008-0827-9. PMid:19011884.

30.Raju KS, Auld BJ. A randomised prospective study of laparoscopic vaginal hysterectomy versus abdominal hysterectomy each with bilateral salpingo- oophorectomy. BJOG. 1994;101(12):1068-71. http://dx.doi.org/10.1111/j.1471-0528.1994.tb13583.x. PMid:7826960.

56fe7c8c5ce02a0f36000000 autopsy Articles

Autops Case Rep

Share this page
Page Sections