Laparoscopic-Assisted Vaginal Hysterectomy for Uteri Weighing 1000 Grams or More

INTRODUCTION Prospective randomized trials have proven the benefits of laparoscopic-assisted vaginal hysterectomy (LAVH) compared with abdominal hysterectomy. The purpose of this study was to evaluate the safety and efficacy of LAVH performed for uteri weighing > or =1000 grams. METHODS Fifteen patients underwent attempted LAVH for uteri >1000g. Median age was 45 years old (range, 31 to 57), and median weight was 170 pounds (range, 130 to 236); 64% had medical comorbidities, and 43% had prior pelvic surgery. Five ports (5 mm) were used to allow maximum uterine manipulation. Uterine vessels were doubly coagulated. RESULTS Fourteen of 15 cases (93%) were successfully completed laparoscopically. Median uterine weight was 1090 grams (range, 1000 to 1650). Median operative time was 3.5 hours (range, 2 to 4.6), and median blood loss was 400 mL (range, 100 to 1200). All patients were discharged on postoperative day one, and no patients developed a postoperative complication. CONCLUSION We believe that LAVH is a safe and effective approach for uteri larger than 1000 g. It is our opinion that 3 surgical techniques are required; maximum Trendelenburg position, adequate number of ports, and double coagulations of the uterine vessels.