Total laparoscopic hysterectomy outcomes for large uterus (>14weeks) due to large and multiple fibroids

Abstract

Objective: Total laparoscopic hysterectomy (TLH) seems to be the best surgical route for most cases. However, the technical difficulties, while removing a large uterus due to huge fibroids should be noted. The aim of this study was to assess the effect of large uterine size (>14 weeks) due to large fibroids on the outcome of TLH. Material and Methods: A total of 234 TLH cases were included in the study. The study group consisted of the patients with clinical size >14 gestational weeks uterus (n=99). The control group consisted of patients with smaller uterine size and operated with benign indications (n=135). The groups were comparable regarding body mass index, comorbidities, and previous abdominal surgery. Results: The mean duration of operation, estimated blood loss and the rates of complications were similar between the groups. The rate of conversion to laparotomy did not show a statistically significant difference between the groups. There were five conversions in the study group due to excessive bleeding (n=2), inability to mobilize the uterus (n=2), and intestinal injury (n=1). The two conversions in the control group were also due to excessive bleeding. Conclusion: Total laparoscopic hysterectomy for large uterine size >14 weeks size due to large fibroids seems to be a safe and successful surgical approach.