Laparoscopic subtotal hysterectomy for large uteri using modified five port technique.
OBJECTIVE
To evaluate outcome of laparoscopic subtotal hysterectomy (LASH) performed in women with large uteri using a modified five port technique.


METHODS
Prospective Cohort Study (Canadian Task Force classification III).


METHODS
Advanced laparoscopic Unit at the Whipps Cross University Hospital, London, UK.


METHODS
(1) All women with symptomatic and large uteri undergoing LASH, (2) previous three normal cervical smears and consent for future smears as protocol, (3) patient consent for the procedure.


METHODS
Prospectively collected database was analysed statistically for 29 women with enlarged uteri weighing more than 300 g who underwent LASH using the modified five port technique, during the time period of 24 months from Jan 2007 to Jan 2009. This technique demonstrates that the port placement facilitates the procedure.


RESULTS
The mean age of the patients was 47 ± 4 years. Median BMI was 29 (range 22-41), Most common indication of surgery was menorrhagia in 90% of cases followed by palpable lump in 67% of cases. Median size of uterus was 18 weeks (range 12-30). Mean operative time was 84 ± 42 min. Median blood loss was 200 ml (range 100-800 ml).There was only one case with major complication such as bladder injury which was diagnosed and repaired intraoperatively. Mean hospital stay was 2 ± 1 day. None of the cases needed conversion to laparotomy.


CONCLUSIONS
Modified five port technique of LASH for large uteri provides optimal exposure of the operative field to increase the efficiency and ease of the procedure and has its added cosmetic benefits.
Shahid
Anupama
A
Whipps Cross University Hospital, Whipps Cross Road, Leytonstone, London, UK.
Sankaran
Sridevi
S
Odejinmi
Funlayo
F
D000328:Adult; D015992:Body Mass Index; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy / Q000379:methods*; D008595:Menorrhagia / Q000601:surgery; D008875:Middle Aged; D009929:Organ Size; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D016896:Treatment Outcome; D014599:Uterus / Q000473:pathology* / Q000601:surgery*