• Jian Zou, Yang Li, and Changkun Zhu.
• Department of Gynecology and Oncology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
• Medicine (Baltimore). 2023 Nov 10; 102 (45): e35981e35981.

RationaleRemoval of a large uterus poses a challenge in minimally invasive surgery for patients with early-stage endometrial cancer. This manuscript presents 3 cases performed the improved surgical procedure with minimal trauma.Patient ConcernsThree patients with obesity (Body Mass Index: 31.93, 30.06, and 51.82 kg/m2) and large uterus (7.3 × 8.0 × 7.6 cm, 8.5 × 8.9 × 8.5 cm, and 8.3 × 10.1 × 6.9 cm) visited our hospital because of vaginal bleeding, and received dilation and curettage. Pathological examination revealed endometrial carcinoma.DiagnosesEndometrial carcinoma, obesity.InterventionLaparoscopy and transverse-abdominal extra-fascial hysterectomy were performed. First, we performed bilateral adnexectomy, pelvic lymph node dissection, and para-aortic lymph node sampling, and exposed and separated the para-uterine tissue and bladder before cutting off the uterus from the vagina through laparoscopy. Second, we made a 10 cm suprapubic transverse incision in the lower abdomen, clamped the vagina using right-angle forceps to follow the principle of tumor-free technique, placed the uterus in a surgical bag for retrieval the uterus immediately from the incision.OutcomeAll 3 patients underwent intestinal recovery for 24 hours post operation; 50 mL blood was lost during the operation with a well-healing wound and no complication. Till date, there has been no recurrence or metastasis in any of them.LessonsImproving the surgical procedure could enhance safety and ease of operation even in cases of obesity and a large uterus.Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.

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