Hysterectomy for Large Uterus by Minimally Invasive Surgery (MIS)

Background and Objective: When the uterus is or more than 18 to 20 weeks in size, laparotomy but not minimally invasive surgery (MIS) is commonly performed for hysterectomy. It is, however, acknowledged that MIS carries numerous benefits to patients compared to laparotomy. The uterine size should therefore not be an excluding factor for MIS. This study aims to demonstrate the feasibility and benefits of MIS for hysterectomy for large uterus and explain specific techniques employed. Methods: Data from 73 laparoscopic and robotic hysterectomy cases were collected. Cases were divided in two groups based on uterine weight (>= 500 g vs <500 g). Estimated blood loss (EBL), operative time, length of hospital stays, and perioperative complications were compared between the groups. Results: The average specimen weight in two groups was 244 +/- 102.75 g vs 903 +/- 438.18 g (P< .01). There was no statistically significant difference in length of hospital stay between the two groups. Only 3 patients were hospitalized for more than one day. There were no instances of conversion to laparotomy, intraoperative or postoperative blood transfusion. There was a statistically significant difference in the EBL (78.19 +/- 43.8 ml vs 127.88 +/- 69.76 ml, P< .01) and operative time (180.68 +/- 48.36 vs 228.85 +/- 53.04 minutes, P< .01) between the two groups. There were two cases of bladder laceration in the group with uterine weight exceeding 500 g. Conclusion: With advanced surgical skills and the adoption of specific techniques, hysterectomy for large uterus can be performed safely and efficiently by MIS.