title: Surgical outcome and complications of total laparoscopic hysterectomy for very large myomatous uteri in relation to uterine weight: a prospective study in a continuous series of 461 procedures.
abstract: To analyze whether a large uterine size was associated with increased rate of intraoperative and postoperative surgical complications in patients who underwent total laparoscopic hysterectomy (TLH) for myomatous uteri.
  
  
  
  We examined prospectively data from 461 consecutive TLHs performed by a single surgeon between August 2004 and August 2014 at the Department of Obstetrics and Gynecology, Sirai Hospital, Carbonia, and at the Department of Gynecologic Oncology, Businco Hospital, Cagliari, Italy. Demographic and surgical data were stratified by uterine weight (range 90-5500 g) into four groups: <300 g; from 300 to 500 g; from 500 to 800 g; and >800 g. Outcomes examined included blood loss, operative time, intraoperative and postoperative complications, and duration of hospital stay. A linear regression analysis was performed to identify whether uterine weight was an independent predictor affecting these outcomes. In addition, BMI, previous surgery with adhesiolysis, and endometriosis were tested as a predictor of surgical complications and outcomes.
  
  
  
  No significant difference was found in intraoperative and postoperative complications, as well as hospital stay, by uterine weight. Increased uterine size was significantly associated with longer operative time and increased blood loss. Beside uterine weight, prior surgery was predictive of postoperative complications. In contrast, higher BMI was not associated with increased complication rate. Independent predictors of longer operative time included previous surgery, endometriosis, and BMI.
  
  
  
  Our results showed that in experienced hands, TLH is feasible and safe also in presence of very large uteri. TLH results in a few complications and short hospital stay regardless of uterine weight.
authors.affiliation: Department of Gynecologic Oncology, A. Businco Hospital, Regional Referral Center for Cancer Diseases, Azienda Ospedaliera Brotzu, Via Jenner, 09100, Cagliari, Italy. a.maccio@tin.it.
authors.forename: Antonio
authors.initials: A
authors.lastname: Macciò
authors.affiliation: Department of Gynecologic Oncology, A. Businco Hospital, Regional Referral Center for Cancer Diseases, Azienda Ospedaliera Brotzu, Via Jenner, 09100, Cagliari, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Chiappe
authors.affiliation: Department of Gynecologic Oncology, A. Businco Hospital, Regional Referral Center for Cancer Diseases, Azienda Ospedaliera Brotzu, Via Jenner, 09100, Cagliari, Italy.
authors.forename: Parakevas
authors.initials: P
authors.lastname: Kotsonis
authors.affiliation: Department of Gynecologic Oncology, A. Businco Hospital, Regional Referral Center for Cancer Diseases, Azienda Ospedaliera Brotzu, Via Jenner, 09100, Cagliari, Italy.
authors.forename: Romualdo
authors.initials: R
authors.lastname: Nieddu
authors.affiliation: Department of Gynecologic Oncology, A. Businco Hospital, Regional Referral Center for Cancer Diseases, Azienda Ospedaliera Brotzu, Via Jenner, 09100, Cagliari, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Lavra
authors.affiliation: Department of Gynecologic Oncology, A. Businco Hospital, Regional Referral Center for Cancer Diseases, Azienda Ospedaliera Brotzu, Via Jenner, 09100, Cagliari, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Serra
authors.affiliation: Department of Gynecologic Oncology, A. Businco Hospital, Regional Referral Center for Cancer Diseases, Azienda Ospedaliera Brotzu, Via Jenner, 09100, Cagliari, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Onnis
authors.affiliation: Department of Oncological Surgery, A. Businco Hospital, Azienda Ospedaliera Brotzu, Cagliari, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Sollai
authors.affiliation: Department of General Surgery, Azienda Ospedaliera Brotzu, Cagliari, Italy.
authors.forename: Fausto
authors.initials: F
authors.lastname: Zamboni
authors.affiliation: Department of Medical Sciences M. Aresu, University of Cagliari, Cagliari, Italy.
authors.forename: Clelia
authors.initials: C
authors.lastname: Madeddu
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects* / Q000379:methods; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D007889:Leiomyoma / Q000601:surgery*; D007902:Length of Stay; D008875:Middle Aged; D009929:Organ Size; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D014594:Uterine Neoplasms / Q000601:surgery*; D014599:Uterus / Q000473:pathology*
keywords: Laparoscopy; Large uteri; Mini-invasive surgery; Myomatous uteri; Women’s health