Background: The laparoscopic hysterectomy of enlarge uterus is a challenge to the surgeon irrespective of the surgical route. Big leiomyomas occupy the pelvis, thus decrease the ability to see the surrounding anatomic structures and partially impairing the surgeon's perform to correctly develop the pelvic spaces..The current work compares of laparoscopic hysterectomy for large uterus (weighing ≥ 280 gm) with an abdominal hysterectomy,
Methods: This prospective interventional clinical study submitted from January 2015 to December 2018 to assess the perioperative outcomes of 60 consecutive women with an enlarged uterus (weighing ≥ 280 gm determined preoperative by ultrasound), of whom 30 underwent laparoscopic hysterectomy and 30 an abdominal hysterectomy, all for benign gynecological conditions after exclusion of contraindications to laparoscopy.
Results: Baseline patient characteristics were similar between the both groups, except for body mass index with laparoscopic group show higher index (34.3±1.3 kg/m2). Among the perioperative complications, only the risk of ileus was significantly higher in the group that underwent abdominal hysterectomy. Laparoscopic hysterectomy shortened the length of hospitalization significantly but did not affect the operative time and blood transfusion.
Conclusion: Total laparoscopic hysterectomy of enlarged uterus is a suitable effective alternative to traditional abdominal hysterectomy when the laparoscopic team is well trained. However more studies are necessary before this technique can become routinely preconized.