Strategies and Outcomes of Total Laparoscopic Hysterectomy for Large Uterine Cervical Fibroids

Background and Objectives: To present the methods and outcomes of total laparoscopic hysterectomy with debulking surgery for large cervical fibroids. Methods: This is a single-center study. Twenty-one women who underwent total laparoscopic hysterectomy between October 1, 2012 and November 30, 2020 for large cervical fibroids (diameter >= 10 cm) based on a diagnosis by magnetic resonance imagining were enrolled. Conventional total laparoscopic hysterectomy for large cervical fibroids was initially attempted. If this could not be completed, debulking surgery, such as enucleation of large cervical fibroids or cervical amputation, was performed during total laparoscopic hysterectomy. Results: Total laparoscopic hysterectomy could be completed in all 21 patients with large cervical fibroids without blood transfusion. Conventional total laparoscopic hysterectomy was performed in four patients (19%), and 17 patients (81%) required debulking surgery at the time of total laparoscopic hysterectomy. The median diameter of the major axis of the cervical fibroid, uterine weight, intraoperative blood loss, and operative time were 12 cm, 750 g, 100 mL, and 191 min, respectively. Conclusion: Total laparoscopic hysterectomy for large cervical fibroids, although minimally invasive, requires a high level of laparoscopic skill. However, our data suggests that total laparoscopic hysterectomy for large cervical fibroids can be feasible, with an acceptable level of blood loss, by performing debulking surgeries such as enucleation of large cervical fibroids or cervical amputation.