title: Minilaparoscopic versus standard laparoscopic hysterectomy for uteri ≥ 16 weeks of gestation: surgical outcomes, postoperative quality of life, and cosmesis.
abstract: OBJECTIVE
  Hysterectomy for enlarged uteri is a surgical challenge. Our aim was to compare perioperative outcomes, cosmesis, and postoperative quality of life following laparoscopic hysterectomy for large uteri using minilaparoscopic 3-mm versus conventional laparoscopic 5-mm instruments.
  
  
  METHODS
  We prospectively enrolled women with a uterus between 16 and 20 weeks of gestation at the preoperative examination. These patients underwent laparoscopic procedures using either 3-mm (minilaparoscopy group) or 5-mm (standard laparoscopy group) instruments. Five months after surgery, patients were called back to fill out the validated Italian translation of the Short Form 12-item Health Survey. Data about the cosmetic outcome of the procedure were also collected, using a Numeric Rating Scale (NRS) from 0 to 10.
  
  
  RESULTS
  Seventy-eight women were included (27 in the 3-mm and 51 in the 5-mm groups). Perioperative characteristics were comparable between groups. The median uterus weight was 575 (range, 440-1050) g and 550 (400-1000) g in the 3-mm and 5-mm groups, respectively. No minilaparoscopic procedure was converted to standard 5-mm or to an open approach. One (2%) conversion to open abdominal surgery was needed in the conventional laparoscopy group. A better subjective cosmetic outcome was found in the 3-mm (NRS, 9.7 ± 0.4) versus the 5-mm (NRS, 8.9 ± 1.2) group (P=.01). Postoperative quality of life was comparable between groups.
  
  
  CONCLUSIONS
  Minilaparoscopic hysterectomy is feasible, even in the case of an enlarged-size uterus. Moreover, it is associated with a better cosmetic outcome, compared with conventional laparoscopy.
authors.affiliation: Department of Obstetrics and Gynecology, University of Insubria , Del Ponte Hospital, Varese, Italy .
authors.forename: Stefano
authors.initials: S
authors.lastname: Uccella
authors.forename: Antonella
authors.initials: A
authors.lastname: Cromi
authors.forename: Jvan
authors.initials: J
authors.lastname: Casarin
authors.forename: Giorgio
authors.initials: G
authors.lastname: Bogani
authors.forename: Maurizio
authors.initials: M
authors.lastname: Serati
authors.forename: Baldo
authors.initials: B
authors.lastname: Gisone
authors.forename: Ciro
authors.initials: C
authors.lastname: Pinelli
authors.forename: Maddalena
authors.initials: M
authors.lastname: Fasola
authors.forename: Fabio
authors.initials: F
authors.lastname: Ghezzi
mesh_terms: D000328:Adult; D000368:Aged; D061887:Conversion to Open Surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000295:instrumentation* / Q000379:methods; D010535:Laparoscopy / Q000295:instrumentation* / Q000379:methods; D008875:Middle Aged; D009929:Organ Size; D011184:Postoperative Period; D011446:Prospective Studies; D011788:Quality of Life; D016896:Treatment Outcome; D014599:Uterus / Q000473:pathology* / Q000601:surgery*