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Surgical outcome and complications of total laparoscopic hysterectomy for very large myomatous uteri in relation to uterine weight: a prospective study in a continuous series of 461 procedures

  • General Gynecology
  • Published:
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Abstract

Purpose

To analyze whether a large uterine size was associated with increased rate of intraoperative and postoperative surgical complications in patients who underwent total laparoscopic hysterectomy (TLH) for myomatous uteri.

Methods

We examined prospectively data from 461 consecutive TLHs performed by a single surgeon between August 2004 and August 2014 at the Department of Obstetrics and Gynecology, Sirai Hospital, Carbonia, and at the Department of Gynecologic Oncology, Businco Hospital, Cagliari, Italy. Demographic and surgical data were stratified by uterine weight (range 90–5500 g) into four groups: <300 g; from 300 to 500 g; from 500 to 800 g; and >800 g. Outcomes examined included blood loss, operative time, intraoperative and postoperative complications, and duration of hospital stay. A linear regression analysis was performed to identify whether uterine weight was an independent predictor affecting these outcomes. In addition, BMI, previous surgery with adhesiolysis, and endometriosis were tested as a predictor of surgical complications and outcomes.

Results

No significant difference was found in intraoperative and postoperative complications, as well as hospital stay, by uterine weight. Increased uterine size was significantly associated with longer operative time and increased blood loss. Beside uterine weight, prior surgery was predictive of postoperative complications. In contrast, higher BMI was not associated with increased complication rate. Independent predictors of longer operative time included previous surgery, endometriosis, and BMI.

Conclusions

Our results showed that in experienced hands, TLH is feasible and safe also in presence of very large uteri. TLH results in a few complications and short hospital stay regardless of uterine weight.

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Acknowledgments

Work supported by the “Associazione Sarda per la ricerca nell’Oncologia Ginecologica-ONLUS” with a funding from Banco di Sardegna Foundation (Grant No. 5335, 2014). The authors thank Cristian Quaggia, Tina di Simone, Martina Trudu, Federica Concas and Andreea Voicu for their technical assistance.

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Authors and Affiliations

  1. Department of Gynecologic Oncology, A. Businco Hospital, Regional Referral Center for Cancer Diseases, Azienda Ospedaliera Brotzu, Via Jenner, 09100, Cagliari, Italy

    Antonio Macciò, Giacomo Chiappe, Parakevas Kotsonis, Romualdo Nieddu, Fabrizio Lavra, Michele Serra & Paolo Onnis

  2. Department of Oncological Surgery, A. Businco Hospital, Azienda Ospedaliera Brotzu, Cagliari, Italy

    Giuseppe Sollai

  3. Department of General Surgery, Azienda Ospedaliera Brotzu, Cagliari, Italy

    Fausto Zamboni

  4. Department of Medical Sciences M. Aresu, University of Cagliari, Cagliari, Italy

    Clelia Madeddu

Authors
  1. Antonio Macciò
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  2. Giacomo Chiappe
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  3. Parakevas Kotsonis
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Correspondence to Antonio Macciò.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments.

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Macciò, A., Chiappe, G., Kotsonis, P. et al. Surgical outcome and complications of total laparoscopic hysterectomy for very large myomatous uteri in relation to uterine weight: a prospective study in a continuous series of 461 procedures. Arch Gynecol Obstet 294, 525–531 (2016). https://doi.org/10.1007/s00404-016-4075-0

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  • DOI: https://doi.org/10.1007/s00404-016-4075-0

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