ABSTRACT
STUDY OBJECTIVE: The purpose of this study was to review outcomes of laparoscopic supracervical hysterectomy (LSH) performed on patients with large uteri and compare those outcomes with existing series of hysterectomies reporting removal of large uteri. DESIGN: Retrospective analysis (Canadian Task Force classification II-3). SETTING: Single surgeon, independent surgery center. PATIENTS: Women with symptomatic myomas and/or menorrhagia. INTERVENTION: Laparoscopic supracervical hysterectomy. MEASUREMENTS AND MAIN RESULTS: All patients undergoing LSH procedures for uteri weighing more than 300 g between the years 1997 and 2001 were evaluated. A retrospective chart review and videotape review were used to assess outcome measures including operative time, complications, estimated blood loss, uterine weight, and pathologic diagnoses. A quality of life questionnaire was submitted to the patients postoperatively. During the 5 years of the study, 329 LSHs were performed, 54 (16.4%) involved uterine weight greater than 300 g, and 31 (67%) of this group had a uterine weight greater than 500 g. Seven patients (2%) had complex pathologies with leiomyomata and endometriosis. There were five cases of reported complications: two intraoperative complications and three postoperative fevers. One procedure was converted to laparotomy. Transfusion rate was 0%, with an average estimated blood loss of 77 mL. The mean number of days to return to work or normal activity was 10.1. Sexual relations were reported to be as good as or better than before the procedure in 88.9% of patients. All the patients reported being satisfied with the procedure. CONCLUSION: The LSH procedure in this series provided an effective, low-morbidity alternative for patients with large uteri to accomplish uterine extirpation. Since reduction of morbidity and improved quality of care for women undergoing hysterectomy are goals of all gynecologists, we believe that LSH is an alternative that should be considered.
Subject(s)
Hysterectomy/methods , Hysteroscopy/methods , Leiomyoma/surgery , Organ Size , Uterine Neoplasms/surgery , Uterus/physiopathology , Adult , Aged , Cervix Uteri , Female , Follow-Up Studies , Humans , Leiomyoma/diagnosis , Length of Stay , Middle Aged , Pain, Postoperative , Postoperative Hemorrhage , Risk Assessment , Severity of Illness Index , Treatment Outcome , Uterine Neoplasms/diagnosisABSTRACT
A 27-year-old woman had a history of acute chronic pelvic pain. She had had a previous salpingo-oophorectomy for an endometrioma. A computerized tomographic scan showed a left adnexal mass. She was known to have bilateral duplicate ureters shown on intravenous pyelogram. She underwent laparoscopy and retroperitoneal dissection of endometriosis with excision of the mass from the pelvic sidewall. The final pathology was consistent with a hemorrhagic corpus luteal cyst.
