title: Minimally Invasive Hysterectomy for Uteri Greater Than One Kilogram.
abstract: OBJECTIVE
  To assess the feasibility and safety of minimally invasive hysterectomy for uteri >1 kg.
  
  
  METHODS
  Clinical and surgical characteristics were collected for patients in an academic tertiary care hospital. Included were patients who underwent minimally invasive hysterectomy by 1 of 3 fellowship-trained gynecologists from January 1, 2009, to July 1, 2015 and subsequently had confirmed uterine weights of 1 kg or greater on pathology report. Both robotic and conventional laparoscopic procedures were included.
  
  
  RESULTS
  During the study period, 95 patients underwent minimally invasive hysterectomy with confirmed uterine weight over 1 kg. Eighty-eight percent were performed with conventional laparoscopy and 12.6% with robot-assisted laparoscopy. The median weight (range) was 1326 g (range, 1000-4800). The median estimated blood loss was 200 mL (range, 50-2000), and median operating time was 191 minutes (range, 75-478). Five cases were converted to laparotomy (5.2%). Four cases were converted secondary to hemorrhage and one secondary to extensive adhesions. There were no conversions after 2011. Intraoperative transfusion was given in 6.3% of cases and postoperative transfusion in 6.3% of cases. However, after 2013, the rate of intraoperative transfusion decreased to 1.0% and postoperative transfusion to 2.1%. Of the 95 cases, there were no cases with malignancy.
  
  
  CONCLUSIONS
  This provides the largest case series of hysterectomy over 1 kg completed by a minimally invasive approach. Our complication rate improved with experience and was comparable to other studies of minimally invasive hysterectomy for large uteri. When performed by experienced surgeons, minimally invasive hysterectomy for uteri >1 kg can be considered feasible and safe.
authors.affiliation: Department of Obstetrics and Gynecology, The George Washington University Hospital.
authors.forename: Traci E
authors.initials: TE
authors.lastname: Ito
authors.affiliation: Department of Obstetrics and Gynecology, The George Washington University Hospital.
authors.forename: Maria V
authors.initials: MV
authors.lastname: Vargas
authors.affiliation: Department of Obstetrics and Gynecology, The George Washington University Hospital.
authors.forename: Gaby N
authors.initials: GN
authors.lastname: Moawad
authors.affiliation: Department of Obstetrics and Gynecology, The George Washington University Hospital.
authors.forename: Jessica
authors.initials: J
authors.lastname: Opoku-Anane
authors.affiliation: The George Washington University Hospital, and the George Washington University Medical School, Washington, DC, USA.
authors.forename: Michael K M
authors.initials: MK
authors.lastname: Shu
authors.affiliation: Department of Obstetrics and Gynecology, The George Washington University Hospital.
authors.forename: Cherie Q
authors.initials: CQ
authors.lastname: Marfori
authors.affiliation: Department of Obstetrics and Gynecology, The George Washington University Hospital.
authors.forename: James K
authors.initials: JK
authors.lastname: Robinson
mesh_terms: D000328:Adult; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D010535:Laparoscopy; D008875:Middle Aged; D009929:Organ Size; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D014599:Uterus / Q000033:anatomy & histology* / Q000601:surgery
keywords: Fibroids; Laparoscopic hysterectomy