title: Safety and efficacy of vaginal hysterectomy in the large uterus with the LigaSure bipolar diathermy system.
abstract: OBJECTIVE
  This study was undertaken to assess safety and efficacy of vaginal hysterectomy in case of large uterine size (> or = 250 g) using the LigaSure bipolar diathermy (Valleylab, Boulder, CO).
  
  
  METHODS
  In a retrospective study, medical records of 102 patients who underwent vaginal hysterectomy and who had uterine weight (evaluated after surgery) 250 g or greater were reviewed. All hysterectomies were performed by using the LigaSure vessel sealing system to secure vascular pedicles (uterosacral-cardinal, uterine and ovarian and round ligaments).
  
  
  RESULTS
  Of the 102 vaginal hysterectomies, 99 were successfully performed (97.1%; 95% confidence interval, 91.6-99.4%), whereas a conversion from the vaginal to the abdominal route was required in 3 cases. The median uterine weight was 455 g (range, 241-1913 g). The weight of the largest uterus successfully removed vaginally was 1600 g, without intraoperative and postoperative complications. The median operative time was 50 minutes (range, 25-50 minutes).
  
  
  CONCLUSIONS
  The current study confirms that very large uterine volume does not represent a real obstacle to perform vaginal hysterectomy and that results in a safe and effective technique in cases of uterine weight 250 g or greater.
authors.affiliation: Unit of Minimally Invasive Gynecology-Ginteam, Torino, Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Mistrangelo
authors.forename: Giorgio
authors.initials: G
authors.lastname: Febo
authors.forename: Barbara
authors.initials: B
authors.lastname: Ferrero
authors.forename: Simone
authors.initials: S
authors.lastname: Ferrero
authors.forename: Francesco
authors.initials: F
authors.lastname: Deltetto
authors.forename: Marco
authors.initials: M
authors.lastname: Camanni
mesh_terms: D000328:Adult; D000368:Aged; D003972:Diathermy / Q000379:methods*; D005260:Female; D006489:Hemostatic Techniques; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D008022:Ligaments / Q000601:surgery; D008875:Middle Aged; D009929:Organ Size; D012189:Retrospective Studies; D016896:Treatment Outcome; D014599:Uterus / Q000033:anatomy & histology*