title: An evaluation of laparoscopic hysterectomy alone versus in combination with laparoscopic myomectomy for patients with uterine fibroids.
abstract: OBJECTIVE
  The purpose of this study was to compare surgical outcomes following conventional laparoscopic hysterectomy (LH) (C-LH) versus the combination method of LH plus laparoscopic myomectomy (LM) (LH+LM) for the treatment of large uterine fibroids.
  
  
  METHODS
  This study was performed in 56 patients (uterine weights ≥500g) who underwent either C-LH or LH+LM performed by the same surgeon between May 2010 and May 2016. LH+LM was performed when C-LH was problematic because of poor visibility and/or mobility due to uterine fibroids.
  
  
  RESULTS
  The C-LH and LH+LM groups consisted of 27 (48%) and 29 (52%) patients, respectively. The clinical characteristics of patients differed significantly only in the median sizes of the dominant fibroid. The sizes of the dominant fibroid in the C-LH and LH+LM groups were 9.5cm and 10.7cm (P=0.04), respectively. Regarding the surgical outcomes for the C-LH and LH+LM groups, the median uterine weights were 558g and 737g (P=0.03), respectively, the median operating times were 156min and 173min (P=0.23), respectively, and the median intraoperative blood losses were 150g and 300g (P=0.0004), respectively. In all patients, LH was performed without conversion to laparotomy and there were no cases of bladder, ureteral, or gastrointestinal tract injury. There were no postoperative complications of Clavien-Dindo scale≥III in either group.
  
  
  CONCLUSIONS
  When C-LH cannot be performed because of large uterine fibroids that cause poor visibility and/or mobility, LH+LM may allow the procedure to be successfully completed without conversion to laparotomy. However, the latter approach increases the risk for intraoperative blood loss.
authors.affiliation: Department of Obstetrics and Gynecology, Takanohara Central Hospital, Nara City, Nara, Japan. Electronic address: ftaniguc@gmail.com.
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Taniguchi
authors.affiliation: Department of Obstetrics and Gynecology, Nara Medical University, Kashiwara City, Nara, Japan.
authors.forename: Natsuki
authors.initials: N
authors.lastname: Koike
authors.affiliation: Department of Obstetrics and Gynecology, Takanohara Central Hospital, Nara City, Nara, Japan.
authors.forename: Tadayuki
authors.initials: T
authors.lastname: Kikukawa
authors.affiliation: Department of Obstetrics and Gynecology, Takanohara Central Hospital, Nara City, Nara, Japan.
authors.forename: Maki
authors.initials: M
authors.lastname: Yabuta
authors.affiliation: Department of Obstetrics and Gynecology, Takanohara Central Hospital, Nara City, Nara, Japan.
authors.forename: Masami
authors.initials: M
authors.lastname: Yamaguchi
authors.affiliation: Department of Obstetrics and Gynecology, Takanohara Central Hospital, Nara City, Nara, Japan; Department of Health Informatics, Kyoto University School of Public Health, Kyoto City, Kyoto, Japan.
authors.forename: Emi
authors.initials: E
authors.lastname: Adachi
authors.affiliation: Department of Health Informatics, Kyoto University School of Public Health, Kyoto City, Kyoto, Japan.
authors.forename: Takeo
authors.initials: T
authors.lastname: Nakayama
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods / Q000706:statistics & numerical data*; D010535:Laparoscopy / Q000379:methods; D007889:Leiomyoma / Q000601:surgery*; D008875:Middle Aged; D012189:Retrospective Studies; D063186:Uterine Myomectomy / Q000379:methods / Q000706:statistics & numerical data*; D014594:Uterine Neoplasms / Q000601:surgery*
keywords: Fibroids; Hysterectomy; Laparoscopy; Mobility; Myomectomy; Visibility