Extraperitoneal laparoscopic hysterectomy for the large uterus

Objective To determine the feasibility of dividing the uterine arteries laparoscopically during extraperitoneal laparoscopic hysterectomy (ELH) for an enlarged uterus. Method Retrospective review of ELHs over a 12-month period. Results A total of 28 women underwent ELH for a fibroid uterus. Additional procedures were performed in seven cases: pelvic lymphadenectomy (PLN) in three, pelvic and aortic lymphadenectomy (PALN) in three, and colposuspension in one. In 13 of the 28 cases the uterus weighed ≥ 500 g (mean 874 g); four weighed 750–1000 g, and three weighed > 1000 g. Considering the 13 patients where the uterus weighed > 500 g, two patients had PLN, and one had PALN in addition to a hysterectomy; the patients’ mean age was 50 years; mean anaesthetic time was 3.25 h; mean blood loss was 565 ml; mean hospital stay was 1.5 days, and two (15%) women were transfused. With respect to the uterine arteries 23/26 (88%) were divided laparoscopically; both arteries in 11 patients, one artery in one patient and neither artery in another patient. None of the women in whom both uterine arteries were divided laparoscopically was transfused, whereas both women in whom one or both uterine arteries were divided vaginally were transfused. Conclusion Both uterine arteries can be divided laparoscopically in most patients undergoing ELH for an enlarged uterus, and laparoscopic division of the uterine arteries may reduce blood loss during morcellation.