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63: Minimally invasive hysterectomy for uteri greater than 1 kilogram

      Objectives

      To assess the feasibility and safety of minimally invasive hysterectomy for uteri greater than 1 kilogram.

      Materials and Methods

      This was a retrospective chart review at an academic tertiary care hospital. Information was gathered for patients who underwent minimally invasive hysterectomy by one of three fellowship trained gynecologists from 2009 to 2015 and had confirmed uterine weights of greater than 1 kilogram.

      Results

      From 2009 to 2015, 95 patients underwent minimally invasive hysterectomy with confirmed uterine weight over 1 kg. Eighty-eight percent were performed with traditional laparoscopy and 12% with robotic-assisted laparoscopy. The mean (SD) uterine weight was 1564 grams (637.5) and ranged from 1000 grams to 4800 grams. The mean (SD) estimated blood loss was 334mL (385.8) and mean (SD) operating time was 203 min (73.7). Five cases were converted to laparotomy (5.2%). Four cases were converted secondary to hemorrhage and one conversion was due to extensive adhesive disease and inability to isolate and lateralize the left ureter safely making it hard to isolate the uterine artery. There were no conversions after 2011. There was one organ injury identified, damage to the serosa of the sigmoid colon during adhesiolysis, which was repaired laparoscopically. Intra-operative transfusion was given in 8.4% of cases and post-operative transfusion in 5.2% of cases. However, after 2013, the rate of intra-operative transfusion decreased to 1.0% and post-operative transfusion to 2.1%. Of the 95 cases there were no cases of malignancy.

      Conclusion

      To our knowledge, this provides the largest case series of hysterectomies over 1 kg completed by a minimally invasive approach. Our complication rate improved with experience and was comparable to other studies of laparoscopic hysterectomy for large uteri. When performed by experienced surgeons, minimally invasive hysterectomy for uteri greater than 1kg can be considered feasible and safe.