GnRH agonist treatment before total laparoscopic hysterectomy for large uteri.
OBJECTIVE
To evaluate whether uterine shrinkage induced by gonadotropin-releasing hormone (GnRH) agonists in women with a large uterus (>14 wks) may facilitate total laparoscopic hysterectomy.


METHODS
Randomized, prospective study (Canadian Task Force classification I).


METHODS
University-affiliated hospital.


METHODS
Sixty-two women with symptomatic uterine myomas (size 16-20 wks).


METHODS
Total laparoscopic hysterectomy for benign pathology.


RESULTS
Before surgery, women were assigned, at a ratio of 1:1 by random selection, to receive injections of triptorelin depot 11.25 mg 3 months before surgery (group A) or no treatment (group B). Uterine volume, mean operating time, uterine weight, drop in hemoglobin, intraoperative complications, conversions to laparotomy, and hospital stay were recorded. Triptorelin decreased uterine volume, calculated by ultrasonography, by 26.5% in group A, whereas the volume remained unchanged in group B. Statistical differences were found between groups concerning uterine weight, operating time, and drop in hemoglobin level. Three patients in group B were converted to laparotomy because of uterine size.


CONCLUSIONS
In women with a large uterus, a 3-month preoperative course of GnRH may facilitate laparoscopic hysterectomy, decreasing uterine size, operating time, and blood loss.
Center of Reconstructive Pelvic Endosurgery, Reproductive Medicine Unit, University of Bologna, Bologna, Italy.
R
R
Seracchioli
S
S
Venturoli
F M
FM
Colombo
A
A
Bagnoli
F
F
Vianello
F
F
Govoni
M
M
Guerrini
B
B
Gualerzi
D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D010535:Laparoscopy; D007889:Leiomyoma / Q000601:surgery*; D008875:Middle Aged; D011300:Preoperative Care; D011446:Prospective Studies; D013997:Time Factors; D017329:Triptorelin Pamoate / Q000627:therapeutic use*; D014594:Uterine Neoplasms / Q000601:surgery*; D014599:Uterus / Q000187:drug effects
D018931:Antineoplastic Agents, Hormonal; D017329:Triptorelin Pamoate