Laparoscopic-assisted vaginal hysterectomy for uteri weighing 1000 grams or more.
BACKGROUND
Prospective randomized trials have proven the benefits of laparoscopic-assisted vaginal hysterectomy (LAVH) compared with abdominal hysterectomy. The purpose of this study was to evaluate the safety and efficacy of LAVH performed for uteri weighing > or =1000 grams.


METHODS
Fifteen patients underwent attempted LAVH for uteri >1000g. Median age was 45 years old (range, 31 to 57), and median weight was 170 pounds (range, 130 to 236); 64% had medical comorbidities, and 43% had prior pelvic surgery. Five ports (5 mm) were used to allow maximum uterine manipulation. Uterine vessels were doubly coagulated.


RESULTS
Fourteen of 15 cases (93%) were successfully completed laparoscopically. Median uterine weight was 1090 grams (range, 1000 to 1650). Median operative time was 3.5 hours (range, 2 to 4.6), and median blood loss was 400 mL (range, 100 to 1200). All patients were discharged on postoperative day one, and no patients developed a postoperative complication.


CONCLUSIONS
We believe that LAVH is a safe and effective approach for uteri larger than 1000 g. It is our opinion that 3 surgical techniques are required; maximum Trendelenburg position, adequate number of ports, and double coagulations of the uterine vessels.
Fanning
James
J
Department of Obstetrics and Gynecology, Summa Health System, Northeastern Ohio Universities College of Medicine, Akron, Ohio, USA.
Fenton
Bradford
B
Switzer
Michella
M
Johnson
Jil
J
Clemons
Jessica
J
D000328:Adult; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D007889:Leiomyoma / Q000601:surgery; D008875:Middle Aged; D009929:Organ Size; D014594:Uterine Neoplasms / Q000601:surgery; D014599:Uterus / Q000473:pathology*