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 1A, n=69) or with LISM (group 1B, 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 2B, 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 1 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.