title: Laparoscopic hysterectomy in large uteri: Experience from a tertiary care hospital in Bangladesh.
abstract: BACKGROUND
  The purpose of this study was to examine the safety and feasibility of laparoscopically assisted vaginal hysterectomy for uteri weighing more than 500 g as compared to uteri weighing less than 500 g in benign gynecological diseases.
  
  
  METHODS
  This was a retrospective study. Patients were admitted through the outpatient department. They were divided into two groups: uterine weight ≥500 g (group 1) and uterine weight >500 g (group 2). There were no exclusion criteria based on the size, number, or location of leiomyomas. The patient characteristics for the two groups were compared in terms of demographic and socioeconomic details, operating time, amount of blood loss, requirement of blood transfusion, need for analgesia, and length of hospital stay.
  
  
  RESULTS
  The characteristics age and BMI were well balanced between the two groups. Uterine weight was 267.2 ± 97.6 g in group 1 and 740.0 ± 371.4 g in group 2 (P < 0.001). Length of operation and amount of blood loss were greater in group 2 than in group 1 (operation: 89.1 ± 26.7 vs 73.3 ± 24.6 min, P < 0.01; blood loss: 570.5 ± 503.6 vs 262.5 ± 270.0 mL, P < 0.001). However, there was no significant difference in hospital stay or incidence of operative complications between the two groups. No patients were switched from laparoscopy to laparotomy during operation. The rate of blood transfusion was lower in group1 than in group 2 (4.9% vs 32.6%; P < 0.001).
  
  
  CONCLUSIONS
  This study demonstrated that despite the increased operating time and blood loss, laparoscopy should be considered instead of laparotomy in cases of large uteri. Laparoscopically assisted vaginal hysterectomy can be performed safely for a large uterus.
authors: Department of Gynecology and Obstetrics, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh.
authors: Samsad
authors: S
authors: Jahan
authors: Government Homeopathic College, Dhaka, Bangladesh.
authors: Akter
authors: A
authors: Jahan
authors: Research Training Management International, Cox's Bazar, Bangladesh.
authors: Mahjabin
authors: M
authors: Joarder
authors: Health Economics Unit, Bangladesh Diabetic Somiti (BADAS), Dhaka, Bangladesh.
authors: Samira Humaira
authors: SH
authors: Habib
authors: Department of Obstetrics and Gynecology, Bangladesh Institute of Health Sciences (BIHS) & Hospital, Dhaka, Bangladesh.
authors: Farzana
authors: F
authors: Sharmin
authors: Department of Gynecology and Obstetrics, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Dhaka, Bangladesh.
authors: Reefat
authors: R
authors: Nayer
mesh_terms: D000328:Adult; D001459:Bangladesh; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000379:methods*; D010535:Laparoscopy; D008875:Middle Aged; D009929:Organ Size; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D014591:Uterine Diseases / Q000601:surgery*; D014599:Uterus / Q000033:anatomy & histology* / Q000601:surgery
keywords: Bangladesh; laparoscopic hysterectomy; large uterus