title: Hand-Assisted Laparoscopic Hysterectomy for Large Uteri.
abstract: OBJECTIVE
  To determine whether laparoscopic hand-assisted hysterectomy for a large uterus had different surgical outcomes compared with traditional open hysterectomy.
  
  
  METHODS
  Retrospective cohort study (Canadian Task Force classification II-2).
  
  
  METHODS
  Academic tertiary care hospital.
  
  
  METHODS
  Women who had undergone laparoscopic hand-assisted hysterectomy for a large uterus were included as the hand-assist group. The control group comprised patients with similar final specimen weight (>1 kg), characteristics (body mass index, age), and surgical history, who underwent open hysterectomy for a large uterus.
  
  
  METHODS
  Laparoscopic hysterectomy using a hand-assist port for laparoscopic portion of the case.
  
  
  RESULTS
  The 2 groups were similar in terms of specimen weight (median, 1765.5 g for hand-assist vs 1215.50 g for controls; p = .29). In univariate analysis, the median operating time was longer in the hand-assist group compared with controls (241.5 minutes vs 185.0 minutes; p = .002), whereas median length of stay was shorter in the hand-assist group (1.0 day vs 3.0 days; p < .0001). These differences remained significant after adjustment for potential confounders in multivariable analysis (p < .05). There was no difference in estimated blood loss (p > .05) between the 2 groups, although the change in hemoglobin was less in the hand-assist group compared with controls in multivariable analysis (adjusted mean.74 vs. 1.8; p = .04). Complications were divided into intraoperative complications (transfusion, consultation, bowel injury, bladder injury, ureter injury, and other), hospital postoperative complications (reoperation, transfusion, slow return of bowel function, ileus, poor pain control, fever of unknown origin, venous thromboembolism, pneumonia, and neuropathy), and complications after discharge (readmission, wound infection). The 2 groups had a similar low rate of complications (p > .05).
  
  
  CONCLUSIONS
  Laparoscopic hand-assist hysterectomy is a feasible alternative to open hysterectomy in patients with a large uterus.
authors.affiliation: Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX.
authors.forename: Teresa M
authors.initials: TM
authors.lastname: Walsh
authors.affiliation: Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX.
authors.forename: Haleh
authors.initials: H
authors.lastname: Sangi-Haghpeykar
authors.affiliation: Department of Obstetrics and Gynecology, St. Luke's Women's Center, San Francisco, CA.
authors.forename: Vicky
authors.initials: V
authors.lastname: Ng
authors.affiliation: Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX.
authors.forename: Robert
authors.initials: R
authors.lastname: Zurawin
authors.affiliation: Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX. Electronic address: xiaoming@bcm.edu.
authors.forename: Xiaoming
authors.initials: X
authors.lastname: Guan
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D015992:Body Mass Index; D005240:Feasibility Studies; D005260:Female; D058733:Hand-Assisted Laparoscopy / Q000379:methods; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000379:methods; D007431:Intraoperative Complications / Q000601:surgery; D007902:Length of Stay / Q000706:statistics & numerical data*; D008875:Middle Aged; D061646:Operative Time; D009929:Organ Size; D011183:Postoperative Complications / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome; D014591:Uterine Diseases / Q000601:surgery*
keywords: Fibroids; Hand-assist; Hand-assisted hysterectomy; Laparoscopic hysterectomy; Large uterus; Total laparoscopic hysterectomy