title: Laparoscopic Versus Open Hysterectomy for Benign Disease in Women with Giant Uteri (≥1500 g): Feasibility and Outcomes.
abstract: STUDY
  
  
  
  To evaluate perioperative outcomes and complications of laparoscopic hysterectomy (LH) in women with giant uteri (≥1.5 kg) compared with open abdominal hysterectomy (AH), which is considered the reference.
  
  
  
  A retrospective analysis of prospectively collected data (Canadian Task Force Classification II-2).
  
  
  
  An academic research center.
  
  
  
  All consecutive women who underwent hysterectomy for uteri weighing ≥1500 g (total = 51) between 2000 and 2015 were analyzed. Twenty-seven (53%) patients had been scheduled for the laparoscopic approach (LH), whereas 24 (48%) had been scheduled for AH.
  
  
  
  Hysterectomy ± mono/bilateral salpingo-oophorectomy.
  
  
  
  Perioperative details, incidence, severity, and type of complications were analyzed according to surgical approach (AH vs LH). We also evaluated the trends over time in terms of perioperative outcomes.
  
  
  
  AH was associated with a shorter operative time (97.5 vs 160 minutes, p = .004) compared with LH. Blood loss (200 vs 225 mL, p = .21) and the decrease in postoperative hemoglobin (-1.2 vs -1.1, p = .89) were similar between AH and LH. Intra- and postoperative complications were similar between the 2 groups; however, hospital stay was significantly shorter in the LH group (median = 3 days vs 1 day, p < .001). A significant trend toward a progressive increase in the use of the minimally invasive approach was registered through the years (p = .001). Parallel to this increase, we observed a significant reduction in terms of length of stay. Moreover, a decrease in the total number of complications, mainly because of a decrease in the rate of early minor events, was observed through the years.
  
  
  
  Our experience shows that LH can be considered a feasible procedure, even in cases of uteri ≥1.5 kg, with significant advantages over open surgery in terms of postoperative hospital stay.
authors.affiliation: Department of Obstetrics and Gynecology, University of Insubria, F. Del Ponte Hospital, Varese, Italy. Electronic address: stefucc@libero.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Uccella
authors.affiliation: Department of Obstetrics and Gynecology, University of Insubria, F. Del Ponte Hospital, Varese, Italy.
authors.forename: Jvan
authors.initials: J
authors.lastname: Casarin
authors.affiliation: Department of Obstetrics and Gynecology, University of Insubria, F. Del Ponte Hospital, Varese, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Marconi
authors.affiliation: Department of Obstetrics and Gynecology, University of Insubria, F. Del Ponte Hospital, Varese, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Cromi
authors.affiliation: Department of Obstetrics and Gynecology, University of Insubria, F. Del Ponte Hospital, Varese, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Morosi
authors.affiliation: Department of Obstetrics and Gynecology, University of Insubria, F. Del Ponte Hospital, Varese, Italy.
authors.forename: Baldo
authors.initials: B
authors.lastname: Gisone
authors.affiliation: Department of Obstetrics and Gynecology, University of Insubria, F. Del Ponte Hospital, Varese, Italy.
authors.forename: Ciro
authors.initials: C
authors.lastname: Pinelli
authors.affiliation: Department of Obstetrics and Gynecology, University of Insubria, F. Del Ponte Hospital, Varese, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Ghezzi
mesh_terms: D000328:Adult; D000368:Aged; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay; D008875:Middle Aged; D061646:Operative Time; D009929:Organ Size; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D014599:Uterus / Q000473:pathology / Q000601:surgery*; D055815:Young Adult
keywords: Complications; Giant uterus; Laparoscopy; Large uterus; Total laparoscopic hysterectomy