title: Laparoscopic supracervical hysterectomy for the large uterus.
abstract: OBJECTIVE
  The purpose of this study was to review outcomes of laparoscopic supracervical hysterectomy (LSH) performed on patients with large uteri and compare those outcomes with existing series of hysterectomies reporting removal of large uteri.
  
  
  METHODS
  Retrospective analysis (Canadian Task Force classification II-3).
  
  
  METHODS
  Single surgeon, independent surgery center.
  
  
  METHODS
  Women with symptomatic myomas and/or menorrhagia.
  
  
  METHODS
  Laparoscopic supracervical hysterectomy.
  
  
  RESULTS
  All patients undergoing LSH procedures for uteri weighing more than 300 g between the years 1997 and 2001 were evaluated. A retrospective chart review and videotape review were used to assess outcome measures including operative time, complications, estimated blood loss, uterine weight, and pathologic diagnoses. A quality of life questionnaire was submitted to the patients postoperatively. During the 5 years of the study, 329 LSHs were performed, 54 (16.4%) involved uterine weight greater than 300 g, and 31 (67%) of this group had a uterine weight greater than 500 g. Seven patients (2%) had complex pathologies with leiomyomata and endometriosis. There were five cases of reported complications: two intraoperative complications and three postoperative fevers. One procedure was converted to laparotomy. Transfusion rate was 0%, with an average estimated blood loss of 77 mL. The mean number of days to return to work or normal activity was 10.1. Sexual relations were reported to be as good as or better than before the procedure in 88.9% of patients. All the patients reported being satisfied with the procedure.
  
  
  CONCLUSIONS
  The LSH procedure in this series provided an effective, low-morbidity alternative for patients with large uteri to accomplish uterine extirpation. Since reduction of morbidity and improved quality of care for women undergoing hysterectomy are goals of all gynecologists, we believe that LSH is an alternative that should be considered.
authors.affiliation: Center for Women's Care and Reproductive Surgery, Atlanta, Georgia, USA.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Lyons
authors.forename: Allyson J
authors.initials: AJ
authors.lastname: Adolph
authors.forename: Wendy K
authors.initials: WK
authors.lastname: Winer
mesh_terms: D000328:Adult; D000368:Aged; D002584:Cervix Uteri; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D015907:Hysteroscopy / Q000379:methods*; D007889:Leiomyoma / Q000175:diagnosis / Q000601:surgery*; D007902:Length of Stay; D008875:Middle Aged; D009929:Organ Size; D010149:Postoperative Pain; D019106:Postoperative Hemorrhage; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000175:diagnosis / Q000601:surgery*; D014599:Uterus / Q000503:physiopathology*