Laparoscopic-Assisted Vaginal Hysterectomy with in Situ Morcellation for Large Uteri

Study Objective: To estimate whether laparoscopic in situ morcellation ( LISM) can facilitate laparoscopic-assisted vaginal hysterectomy (LAVH) for large uteri. Design: Prospective study (Canadian Task Force classification II-1). Setting: University-affiliated hospital. Patients: In all, 147 women with myoma or adenomyosis weighing more than 500 g from January 2004 through December 2007 were enrolled. The patients were divided into 4 subgroups: patients with uteri weighing 500 to 749 g who had traditional LAVH without LISM( group I A, n = 69) or with LISM (group I B, n = 16); and patients with uteri weighing 750 g or more who were treated by traditional LAVH without LISM (group 2A, n = 38) or with LISM ( group 213, n = 24). Interventions: Laparoscopic- assisted vaginal hysterectomy with or without LISM. Measurement and Main Results: No significant differences existed in age, body mass index, preoperative diagnoses, complications, or duration of hospital stay among groups. The mean uterine weights were 608 75, 597 +/- 66, 989 +/- 179, and 935 226 g for groups 1A, 1B, 2A, and 2B, respectively. The operative time (120 16 vs 157 36 minutes, p <.001; 140 +/- 19 vs 224 +/- 57 minutes, p <.001) were significantly shorter in patients with LISM than without in both groups I and 2, The estimated blood loss was highest in group 2A. Six (16%) patients lost more than 500 mL of blood and 3 (8%) of them needed blood transfusions. Conversion to laparotomy occurred in 1 (2.6%) of 38 patients in group 2A. No repeated surgery or surgical mortality Occurred. Conclusion: Laparoscopic-assisted vaginal hysterectomy with LISM was an efficient and safe procedure for removal of large uteri during LAVH