title: Total laparoscopic hysterectomy for very enlarged uteri.
abstract: OBJECTIVE
  To evaluate short-term outcome of total laparoscopic hysterectomy (TLH) performed in women with very enlarged uteri.
  
  
  METHODS
  Case control study (Canadian Task Force classification II-2).
  
  
  METHODS
  Hospital gynecologic service.
  
  
  METHODS
  Thirty-four consecutive women with very enlarged uteri.
  
  
  METHODS
  Total laparoscopic hysterectomy for benign pathology.
  
  
  RESULTS
  Women with uterine enlargement (group 1) were compared with 68 women with uteri weighing 300 g or less (group 2) who underwent TLH during the same period. Matching was based on patient age +/- 2 years, surgeon (experienced senior, fellow), whether or not Burch operation was performed, and whether or not adnexectomy was performed. The groups were compared for complication rates, operating time, hospital stay, change in perioperative hemoglobin concentration, and vaginal and laparoscopic uterine morcellation. They did not differ statistically significantly in terms of indications for surgery, parity, postmenopausal status, and preoperative hemoglobin levels. No difference was seen in complication rates between groups. Operating time was significantly shorter (p <0.001) in women with smaller uteri than in those with very enlarged uteri, 108 +/- 35 and 156 +/- 50 minutes, respectively. The groups did not differ significantly in day 1 hemoglobin level drop, analgesia requirement (oral, intravenous opioid), time to passing gas and stool, or hospital stay. No conversion to laparotomy was required in either group.
  
  
  CONCLUSIONS
  A very enlarged uterus should not be considered a contraindication for TLH. However, it may be necessary to undertake certain surgical steps to ensure optimal exposure of the operative field and more effective and safer excision of the uterine vascular pedicle.
authors.affiliation: Department of Obstetrics and Gynecology and Reproductive Medicine, Polyclinique de L'Hotel-Dieu CHU, 13 Boulevard Charles de Gaulle, Clermont-Ferrand, France.
authors.forename: A
authors.initials: A
authors.lastname: Wattiez
authors.forename: D
authors.initials: D
authors.lastname: Soriano
authors.forename: A
authors.initials: A
authors.lastname: Fiaccavento
authors.forename: M
authors.initials: M
authors.lastname: Canis
authors.forename: R
authors.initials: R
authors.lastname: Botchorishvili
authors.forename: J
authors.initials: J
authors.lastname: Pouly
authors.forename: G
authors.initials: G
authors.lastname: Mage
authors.forename: M A
authors.initials: MA
authors.lastname: Bruhat
mesh_terms: D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy; D007902:Length of Stay; D008875:Middle Aged; D016896:Treatment Outcome; D014599:Uterus / Q000473:pathology*