A Combined Laparoscopy and Minilaparotomy Hysterectomy for Large Fibroid Uteri of More Than 1000 Grams-a Personal Experience / 中国微创外科杂志

ABSTRACT

Objective To introduce the surgical outcome of a combined laparoscopy and minilaparotomy hysterectomy (LMH) approach for the management of very large fibroid uteri. Methods From May 2011 to December 2013, 10 women underwent a combined laparoscopy and laparotomy hysterectomy for very large fibroid uteri ( larger than 1000 grams) .Among them, 6 cases combined with salpingo-oophorectomy. The patient characteristics, surgical data and clinical outcome are presented retrospectively.Briefly, this combined laparoscopy and minilaparotomy approach is to use the laparoscopy to perform a prior assessment of the ovaries, tubes, adhesions, sizes and positions of fibroids.A minilaparotomy wound of less than 6 cm is performed.Under the laparoscopic lighting and vision, coagulation of ovarian or uterine vessels can be performed via the minilaparotomy wound.Similarly round ligaments, tubes or ovarian infundibulo-pelvic ligaments can also be coagulated and divided using conventional open surgical instruments and technique.For very large fibroid uteri, tissue reduction by myomectomy is often necessary prior to a standard open hysterectomy for small sized uterus or to perform a subtotal hysterectomy to separate the large fibroid uterus from the cervix, the large uterus can be removed via the minilaparotomy wound with morcellation techniques as described previously in the literature. Results All hysterectomies were successfully completed without any intraoperative or postoperative complication.The mean operation time is 2 hours.All patients recovered well after operation and had an early discharge from hospital (1.5 -3 d). Conclusions This combined laparoscopy and minilaparotomy approach for hysterectomy can replace open abdominal hysterectomy for very large fibroid uterus more than 1000 g.It is a safe and feasible alternative to laparoscopic hysterectomy as a minimally invasive surgery.