title: Laparoscopic hysterectomy of large uteri with uterine artery coagulation at its origin.
abstract: BACKGROUND
  To argue the usefulness for performing total laparoscopic hysterectomy with primary uterine artery coagulation at its origin for a series of women presenting with an enlarged benign uterus.
  
  
  METHODS
  Eighteen women having undergone the procedure consecutively during a period of 17 months were studied retrospectively. The inclusion criteria were an enlarged benign uterus weighing more than 280 g, managed by total laparoscopic hysterectomy with primary uterine artery coagulation at its origin.
  
  
  RESULTS
  Patient median values (range) for age, body mass index, and parity were respectively 47.5 years (range, 38 to 53), 25 kg/m2 (range, 19.3 to 34.9), and 2 (range, 0 to 3). The median value for uterine weight (range) was 540 g (range, 280 to 1,015), and the median duration for the surgical procedure was 185 minutes (range, 90 to 260), the longest procedures being due to associated deep endometriosis resection and extensive adhesions. The duration of the intervention was not significantly correlated with uterine size (correlation coefficient r=-0.15, P=0.56), and no intra- or postoperative complications were recorded.
  
  
  CONCLUSIONS
  The selective coagulation of the uterine artery at its origin is a reproducible technique that allows total laparoscopic hysterectomy in enlarged uteri. This procedure avoids unexpected intraoperative hemorrhage requiring conversion to the abdominal route and provides optimal protection for the ureter.
authors.affiliation: Department of Gynecology and Obstetrics, University Hospital Rouen, France. horace.roman@gmail.com
authors.forename: Horace
authors.initials: H
authors.lastname: Roman
authors.forename: Joel
authors.initials: J
authors.lastname: Zanati
authors.forename: Ludovic
authors.initials: L
authors.lastname: Friederich
authors.forename: Benoit
authors.initials: B
authors.lastname: Resch
authors.forename: Eric
authors.initials: E
authors.lastname: Lena
authors.forename: Loic
authors.initials: L
authors.lastname: Marpeau
mesh_terms: D000328:Adult; D001158:Arteries / Q000601:surgery; D004564:Electrocoagulation; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D014599:Uterus / Q000098:blood supply*