Large Uteri No Problem for Laparoscopic-Assisted Vaginal Hysterectomy

OB/GYN News,  Jan 15, 2000  by Maureen Donohue

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LAS VEGAS -- Laparoscopic-assisted vaginal hysterectomy can be performed safely even in women with very large uteri, according to results of a 150-patient series.

Uteri weighing 70-9 10 g were removed using a two- or three-port laparoscopic technique with an average blood loss of less than 100 cc, according to Dr. Gerard Pregenzer of the Muhlenberg Regional Medical Center in Warren, NJ.

Fifty of the uteri weighed more than 200 g, Dr. Pregenzer reported at the annual meeting of the American Association of Gynecologic Laparoscopists.

The two-port procedure, involving a 10-mm operative laparoscope and a 5-mm secondary port, was used in 40 surgeries; the remaining 110 surgeries used the three-port procedure, with 5-mm cannulas at all sites.

For larger uteri, a 10-mm Gynecare morcellator was inserted through the 10-mm port. This morcellator has a retractable blade, which minimizes damage to the surrounding tissues, Dr. Pregenzer said during the meeting.

Bipolar coagulation was used in all patients.

All but two patients were discharged by postoperative day 2.

This technique provides a safe and cosmetically appealing means of removing even extremely large uteri when performing hysterectomy, Dr. Pregenzer said.

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