• Antonio Macciò, Giacomo Chiappe, Parakevas Kotsonis, Romualdo Nieddu, Fabrizio Lavra, Michele Serra, Paolo Onnis, Giuseppe Sollai, Fausto Zamboni, and Clelia Madeddu.
• Department of Gynecologic Oncology, A. Businco Hospital, Regional Referral Center for Cancer Diseases, Azienda Ospedaliera Brotzu, Via Jenner, 09100, Cagliari, Italy. a.maccio@tin.it.
• Arch. Gynecol. Obstet. 2016 Sep 1; 294 (3): 525-31.

PurposeTo analyze whether a large uterine size was associated with increased rate of intraoperative and postoperative surgical complications in patients who underwent total laparoscopic hysterectomy (TLH) for myomatous uteri.MethodsWe examined prospectively data from 461 consecutive TLHs performed by a single surgeon between August 2004 and August 2014 at the Department of Obstetrics and Gynecology, Sirai Hospital, Carbonia, and at the Department of Gynecologic Oncology, Businco Hospital, Cagliari, Italy. Demographic and surgical data were stratified by uterine weight (range 90-5500 g) into four groups: <300 g; from 300 to 500 g; from 500 to 800 g; and >800 g. Outcomes examined included blood loss, operative time, intraoperative and postoperative complications, and duration of hospital stay. A linear regression analysis was performed to identify whether uterine weight was an independent predictor affecting these outcomes. In addition, BMI, previous surgery with adhesiolysis, and endometriosis were tested as a predictor of surgical complications and outcomes.ResultsNo significant difference was found in intraoperative and postoperative complications, as well as hospital stay, by uterine weight. Increased uterine size was significantly associated with longer operative time and increased blood loss. Beside uterine weight, prior surgery was predictive of postoperative complications. In contrast, higher BMI was not associated with increased complication rate. Independent predictors of longer operative time included previous surgery, endometriosis, and BMI.ConclusionsOur results showed that in experienced hands, TLH is feasible and safe also in presence of very large uteri. TLH results in a few complications and short hospital stay regardless of uterine weight.

23 keywords...

hide…