title: Systematic implementation of laparoscopic hysterectomy independent of uterus size: clinical effect.
abstract: OBJECTIVE
  To investigate the effect of uterine weight on the mode of hysterectomy and on perioperative outcomes and to explore how the increasing experience in endoscopic techniques influenced our choice of surgical approach to hysterectomy to treat benign conditions.
  
  
  METHODS
  Retrospective analysis (Canadian Task Force classification II-2).
  
  
  METHODS
  University-based department of obstetrics and gynecology.
  
  
  METHODS
  A series of 1518 consecutive women with benign uterine conditions other than pelvic organ prolapse who underwent hysterectomy at our department between January 2000 and December 2011.
  
  
  METHODS
  Gradual implementation of the laparoscopic approach over years, with the goal of attempting endoscopic hysterectomy whenever possible and irrespective of uterine weight. Comparisons were made on the basis of various approaches to hysterectomy including vaginal hysterectomy (VH), abdominal hysterectomy (AH), and total laparoscopic hysterectomy (TLH) and on uterine weight.
  
  
  RESULTS
  Hysterectomies performed included 568 VH (37.4%), 234 AH (15.4%), and 716 TLH (47.2%). Postoperative complications were lower in the TLH group vs the AH group; no significant difference was observed between the VH vs TLH groups or the AH vs VH groups. A marked reduction in the need for open surgery was noted between 2000 and 2011 (p for trend <.001). Restricting the analysis to TLH, an increase in operative time and blood loss was observed, parallel to increasing uterine weight. Hospital stay and rate of intraoperative and postoperative complications were independent of uterine weight. In 45 women with uterus weight ≥1000 g, the initial approach was via laparoscopy, with a success rate of 95.6% (n = 43). A marked tendency toward reduction in the use of open surgery was observed through the years when uterine weight was ≥1 kg (p for trend <.001).
  
  
  CONCLUSIONS
  Systematic implementation of laparoscopic hysterectomy enables a marked reduction in the need for AH. In experienced hands, even very large uteri (≥1 kg) can be safely removed via laparoscopy.
authors.affiliation: Department of Obstetrics and Gynecology, University of Insubria, Del Ponte Hospital, Varese, Italy. stefucc@libero.it
authors.forename: Stefano
authors.initials: S
authors.lastname: Uccella
authors.forename: Antonella
authors.initials: A
authors.lastname: Cromi
authors.forename: Giorgio
authors.initials: G
authors.lastname: Bogani
authors.forename: Jvan
authors.initials: J
authors.lastname: Casarin
authors.forename: Giorgio
authors.initials: G
authors.lastname: Formenti
authors.forename: Fabio
authors.initials: F
authors.lastname: Ghezzi
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy; D008875:Middle Aged; D009929:Organ Size; D012189:Retrospective Studies; D016896:Treatment Outcome; D014591:Uterine Diseases / Q000473:pathology / Q000601:surgery*; D014599:Uterus / Q000473:pathology / Q000601:surgery*
keywords: Abdominal hysterectomy; Laparoscopy; Large uterus; Myoma; Total laparoscopic hysterectomy; Vaginal hysterectomy