Total laparoscopic hysterectomy compared with abdominal hysterectomy in the presence of a large uterus

Study Objective. To evaluate in a prospective series whether, even in presence of a large uterus, total laparoscopic hysterectomy is feasible and safe, and may be substituted for abdominal hysterectomy. Design. Randomized comparison (Canadian Task Force classification 1). Setting. Center for Reconstructive Pelvic Endosurgery, Bologna, Italy. Patients. One hundred twenty-two women with large uterus (>14 wks' gestation) caused by myomas. Interventions. Total laparoscopic hysterectomy and total abdominal hysterectomy. Measurements and Main Results. Sixty women underwent laparoscopic hysterectomy (group 1) and 62 abdominal hysterectomy (group 2). Mean longitudinal diameter of the uterus, mean number and diameter of myomas, operating time, and average drop in hemoglobin were similar in the groups. One conversion to laparotomy was necessary because of a bowel injury in a patient with severe pelvic adhesions. Cystotomy occurred in one woman in group 2 and was immediately repaired. Febrile morbidity was statistically more frequent in group 2 than in group 1. Postoperative hospitalization and convalescence were statistically shorter in group 1. Conclusion. Laparoscopic hysterectomy is safe and feasible even in the presence of large uterus, and is a valid alternative to abdominal hysterectomy when the vaginal route is contra indicated.