title: Laparoscopic supracervical hysterectomy for the larger uterus (>500 g): a case series and literature review.
abstract: BACKGROUND
  In clinical practice, the current trend for surgical hysterectomy for the large uterus is by laparotomy, where vaginal hysterectomy is not feasible. The benefits of a laparoscopic approach to hysterectomy are well documented, but limited literature is available on laparoscopic hysterectomy in the larger uterus. A supracervical hysterectomy should be considered for women, where there is no contraindication to a residual cervix.
  
  
  OBJECTIVE
  To compare surgical outcomes for laparoscopic supracervical hysterectomy (LSH) in the large uterus (equal or greater than 500 g) compared with normal (<500 g), results were compared to the limited literature on this topic.
  
  
  METHODS
  A retrospective review was undertaken of 207 women who underwent an LSH between 2005 and 2015 at Whipps Cross University hospital. The operative outcome of patients undergoing surgery, for uteri both greater than 500 g and less than 500 g, was analysed. Data included patient demographics, intra-operative details, and complications. A literature search was performed using keywords 'laparoscopic supracervical hysterectomy' and 'laparoscopic sub-total hysterectomy' which yielded six informative articles.
  
  
  RESULTS
  In the study group of 207 patients, 67 had a large uterus (56 patients 500-1000 g, 11 patients >1000 g). The operation time and intra-operative blood loss were both greater in the larger uterus cohort (P < 0.0001 and P = 0.0021, respectively). The hospital stay and intra-operative complication rate were similar for the two study cohorts (six for the study, n = 207). Review of the literature revealed six relevant studies evaluating patients with uteri greater than 500 g. There was an agreement between all the studies that a larger uterus resulted in an increase in both intra-operative time and blood loss, but this did not translate to increase in hospital stay or intra-operative complications.
  
  
  CONCLUSIONS
  The use of LSH for the larger uterus is feasible and safe due to the low level of operative complications as demonstrated in our study and following a review of the literature.
authors.affiliation: Department of Obstetrics and Gynaecology, Whipps Cross University Hospital, Barts Health NHS Trust, Whipps Cross Road, Leytonstone, London, E11 1NR, England, UK. l.a.mcgurk@me.com.
authors.forename: Lauren
authors.initials: L
authors.lastname: McGurk
authors.affiliation: Department of Obstetrics and Gynaecology, Whipps Cross University Hospital, Barts Health NHS Trust, Whipps Cross Road, Leytonstone, London, E11 1NR, England, UK.
authors.forename: Reeba
authors.initials: R
authors.lastname: Oliver
authors.affiliation: Department of Obstetrics and Gynaecology, Whipps Cross University Hospital, Barts Health NHS Trust, Whipps Cross Road, Leytonstone, London, E11 1NR, England, UK.
authors.forename: Funlayo
authors.initials: F
authors.lastname: Odejinmi
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000379:methods*; D007431:Intraoperative Complications / Q000209:etiology; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies; D014599:Uterus / Q000601:surgery*
keywords: Intra-operative complications; Laparoscopic supracervical hysterectomy; Large uterus; Surgical outcome