Laparoscopic-Assisted Vaginal Hysterectomy with In Situ Morcellation for Large Uteri

Study ObjectiveTo estimate whether laparoscopic in situ morcellation (LISM) can facilitate laparoscopic-assisted vaginal hysterectomy (LAVH) for large uteri.DesignProspective study (Canadian Task Force classification II-1).SettingUniversity-affiliated hospital.PatientsIn all, 147 women with myoma or adenomyosis weighing more than 500 g from January 2004 through December 2007 were enrolled. The patients were divided into 4 subgroups: patients with uteri weighing 500 to 749 g who had traditional LAVH without LISM (group 1A, n = 69) or with LISM (group 1B, n = 16); and patients with uteri weighing 750 g or more who were treated by traditional LAVH without LISM (group 2A, n = 38) or with LISM (group 2B, n = 24).InterventionsLaparoscopic-assisted vaginal hysterectomy with or without LISM.Measurement and Main ResultsNo significant differences existed in age, body mass index, preoperative diagnoses, complications, or duration of hospital stay among groups. The mean uterine weights were 608 ± 75, 597 ± 66, 989 ± 179, and 935 ± 226 g for groups 1A, 1B, 2A, and 2B, respectively. The operative time (120 ± 16 vs 157 ± 36 minutes, p <.001; 140 ± 19 vs 224 ± 57 minutes, p <.001) were significantly shorter in patients with LISM than without in both groups 1 and 2. The estimated blood loss was highest in group 2A. Six (16%) patients lost more than 500 mL of blood and 3 (8%) of them needed blood transfusions. Conversion to laparotomy occurred in 1 (2.6%) of 38 patients in group 2A. No repeated surgery or surgical mortality occurred.ConclusionLaparoscopic-assisted vaginal hysterectomy with LISM was an efficient and safe procedure for removal of large uteri during LAVH.