title: Preoperative assessment by magnetic resonance imaging is useful for planning the treatment of an enlarged uterus by total laparoscopic hysterectomy.
abstract: OBJECTIVE
  The purpose of this study was to compare the intraoperative and postoperative parameters among the three approaches used to treat large uterine myomas: laparoscopic assisted vaginal hysterectomy (LAVH), total laparoscopic hysterectomy (TLH) and abdominal hysterectomy, and to evaluate the selection criteria for laparoscopic hysterectomy as determined by magnetic resonance imaging.
  
  
  METHODS
  The medical records of 155 patients who underwent a hysterectomy between January 2007 and April 2010 were examined. We also compared the indications and outcomes of LAVH and TLH for myomas larger than 7 cm.
  
  
  RESULTS
  Patients who underwent LAVH or TLH had a lower average intraoperative blood loss, less intense postoperative pain, and shorter hospital stays than patients in the TAH group, although the length of the operations in the laparoscopic groups were significantly longer. To evaluate the selection criteria for the large sized myomas, we compared the LAVH and TLH groups for the myomas larger than 7 cm. The greatest uterine transverse diameters and the weight of the uteri were not significantly different between the LAVH and TLH groups (94.7 ± 20.8 and 83.1 ± 17.6 mm, 371.6 ± 160.3 and 286.7 ± 158.0 g, respectively). The average intraoperative blood loss in the TLH group was significantly lower than that in the LAVH (121.3 ± 111.2 vs 379.3 ± 222.4 g, P < 0.001).
  
  
  CONCLUSIONS
  Our data suggest that TLH is a better procedure for treating a large uterus no larger than 10 cm in its greatest transverse diameter. The preoperative total length of myoma nodules determined by MRI is a useful preoperative indicator of the uterine weight.
authors: Department of Obstetrics and Gynecology, Osaka Medical College, Takatsuki, Osaka, Japan.
authors: Koji
authors: K
authors: Hatta
authors: Yoshito
authors: Y
authors: Terai
authors: Kiyoji
authors: K
authors: Okuda
authors: Yoshihiro
authors: Y
authors: Nakamura
authors: Saha
authors: S
authors: Yoo
authors: Yoshimichi
authors: Y
authors: Tanaka
authors: Satoshi
authors: S
authors: Tsunetoh
authors: Atsushi
authors: A
authors: Hayashi
authors: Yoshiki
authors: Y
authors: Yamashita
authors: Masahide
authors: M
authors: Ohmichi
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical / Q000517:prevention & control; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D007564:Japan; D010535:Laparoscopy; D007889:Leiomyoma / Q000473:pathology* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009929:Organ Size; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D047368:Tumor Burden; D014594:Uterine Neoplasms / Q000473:pathology* / Q000601:surgery; D014599:Uterus / Q000473:pathology* / Q000601:surgery