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Feasibility and safety of total laparoscopic hysterectomy for uteri weighing from 1.5 kg to 11.000 kg

  • General Gynecology
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Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To assess the feasibility and safety of total laparoscopic hysterectomy (TLH) for uteri ≥ 1.5 kg.

Methods

We prospectively evaluated all elective TLHs (with or without adnexectomy) performed for fibromatous uteri between August 2009 and August 2019 in the Department of Obstetrics and Gynecology, Sirai Hospital, Carbonia, and the Department of Gynecologic Oncology, Businco Hospital, Azienda Ospedaliera Brotzu, Cagliari. Patients with large myomatous uteri (uterine weight ≥ 1.5 kg on pathology reports) were included in the analysis. We examined all procedures and collected data about intra- and post-operative short-term and long-term complications, intraoperative blood loss, operative time, hospital stay, and time to achieve well-being.

Results

Seventy-eight patients were included. The median weight was 2,000 g (range 1,500–11,000 g), estimated blood loss was 100 mL (range 10–700 mL), operating time was 135 min (range 60–300 min), and hospital stay was 2 days (range 2–5 days). Conversion to laparotomy occurred in 4 patients (5.1%) with uterine weight ranging from 3 to 5.5 kg, due to severe adherence syndrome or inadequate visualization. As for intraoperative complications, 1 patient (who had the largest removed uterus weighing 11,000 g) experienced an intraoperative ureteral injury (grade III). No major postoperative complications occurred.

Conclusions

This study provides the largest case series of TLH for fibromatous uteri > 1.5 kg and includes some of the largest uteri reported to date in the literature (weighing 5,320, 5,720, and 11,000 g, respectively). The study reaffirms the feasibility and safety of a minimally invasive hysterectomy even in the case of abnormally large uteri.

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Acknowledgements

Work supported by Associazione Sarda per la Ricerca in Ginecologia Oncologica. The authors thank the President of the Sardinian Region for his encouragement in the development of this research.

Funding

Not applicable.

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Authors and Affiliations

  1. Department of Gynecologic Oncology, Azienda Ospedaliera Brotzu, Via Jenner, 09100, Cagliari, Italy

    Antonio Macciò, Giacomo Chiappe, Paraskevas Kotsonis, Fabrizio Lavra, Elisabetta Sanna & Ivan Collu

  2. Department of Pathology, Azienda Ospedaliera Brotzu, Cagliari, Italy

    Sonia Nemolato

  3. Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy

    Clelia Madeddu

Authors
  1. Antonio Macciò
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  2. Giacomo Chiappe
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  3. Paraskevas Kotsonis
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  4. Fabrizio Lavra
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  5. Elisabetta Sanna
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  6. Ivan Collu
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  7. Sonia Nemolato
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  8. Clelia Madeddu
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Contributions

A Macciò: Protocol conceptualization and development, data collection, data analysis, manuscript writing and editing, funding acquisition, methodology and surgery coordination; G Chiappe: data collection, data analysis, manuscript writing and editing curation, surgical procedures performance; F Lavra: data collection, data analysis, manuscript writing and editing, surgical procedures performance; E Sanna: data collection, data analysis, manuscript writing and editing, surgical procedures performance; I Collu: data collection, data analysis, manuscript editing, supervision and coordination of surgical procedures; S Nemolato: data collection, data analysis, manuscript editing, pathology reports; C Madeddu: Protocol development, data collection, data analysis, manuscript writing and editing.

Corresponding author

Correspondence to Antonio Macciò.

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The authors report no conflict of interest.

Ethical approval

In accordance with the Italian Regulatory Agency for observational studies not involving drugs, the Institutional Review Board approval was not required.

Informed consent

Patients provided written informed consent for the surgery, study participation, and the utilization of the data and use of imaging.

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Macciò, A., Chiappe, G., Kotsonis, P. et al. Feasibility and safety of total laparoscopic hysterectomy for uteri weighing from 1.5 kg to 11.000 kg. Arch Gynecol Obstet 303, 169–179 (2021). https://doi.org/10.1007/s00404-020-05799-6

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  • DOI: https://doi.org/10.1007/s00404-020-05799-6

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