title: LAVH for large uteri by various strategies.
abstract: BACKGROUND
  To study if there are specific problems in laparoscopically assisted vaginal hysterectomy (LAVH) for a certain weight of bulky uteri and the strategies to overcome such problems.
  
  
  METHODS
  One hundred and eighty-one women with myoma or adenomyosis, weighing 350-1,590 g, underwent LAVH between August 2002 and December 2005. Key surgical strategies were special sites for trocar insertion, uterine artery or adnexal collateral pre-ligation, laparoscopic and transvaginal volume reduction technique. The basic clinical and operative parameters were recorded for analysis.
  
  
  RESULTS
  Based on significant differences in the operative time and estimated blood loss, the patients were divided into medium uteri weighing 350-749 g, n=138 (76%), and large uteri weighing > or =750 g, n=43 (24%). There was no significant difference in terms of age, body mass index, preoperative diagnoses, complications and duration of hospital stay among groups. The operative time and estimated blood loss increased with larger uterine size (p<0.001). The operative time (196+/-53, 115-395 min), estimated blood loss (234+/-200, 50-1,000 ml) and frequency of excessive bleeding (14%) or transfusion (5%) were significantly greater, but in acceptable ranges, for those with large uteri. Conversion to laparotomy was required in a patient (2%) with a large uterus, and the overall conversion rate was 0.6%. There was no re-operation or surgical mortality.
  
  
  CONCLUSIONS
  Using various combinations of special strategies, most experienced gynecologic surgeons can conduct LAVH for most large uteri with minimal rates of complications and conversion to laparotomy.
authors.affiliation: Department of Obstetrics and Gynecology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Wen-Chun
authors.initials: WC
authors.lastname: Chang
authors.forename: Su-Cheng
authors.initials: SC
authors.lastname: Huang
authors.forename: Bor-Ching
authors.initials: BC
authors.lastname: Sheu
authors.forename: Pao-Ling
authors.initials: PL
authors.lastname: Torng
authors.forename: Wen-Chiung
authors.initials: WC
authors.lastname: Hsu
authors.forename: Szu-Yu
authors.initials: SY
authors.lastname: Chen
authors.forename: Daw-Yuan
authors.initials: DY
authors.lastname: Chang
mesh_terms: D016063:Blood Loss, Surgical; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000009:adverse effects / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D009929:Organ Size; D014591:Uterine Diseases / Q000601:surgery*; D014599:Uterus / Q000033:anatomy & histology*