Does uterus volume affect the total laparoscopic hysterectomy outcomes? : Results of total laparoscopic hysterectomy

Cevdet Adiguzel; Emre Destegül; Hicran Acar Şirinoğlu; Gülsüm Uysal

doi:10.28982/josam.7280

Authors

Cevdet Adiguzel Department of Obstetrics and Gynecology, University of Health Science Adana City Training and Research Hospital, Adana, Turkey https://orcid.org/0000-0002-3003-4573
Emre Destegül Department of Obstetrics and Gynecology, University of Health Science Adana City Training and Research Hospital https://orcid.org/0000-0001-5726-0223
Hicran Acar Şirinoğlu Division of Perinatology, Department of Obstetrics and Gynecology, Prof. Dr. Cemil Taşcıoğlu City Hospital https://orcid.org/0000-0003-4100-3868
Gülsüm Uysal Department of Obstetrics and Gynecology, University of Health Science Adana City Training and Research Hospital. https://orcid.org/0000-0002-9381-4892

DOI:

https://doi.org/10.28982/josam.7280

Keywords:

Laparoscopic hysterectomy, Uterine volume, Surgery outcome

Abstract

Background/Aim: Increased uterus weight, high body mass index (BMI), and history of abdominal surgeries increase the risk of complications in total laparoscopic hysterectomy (TLH), similar to other types of surgery. However, there are conflicting reports about improving technology. This study aimed to retrospectively investigate the clinical features and postoperative results of TLH cases regarding uterine volume performed for benign reasons in our clinic.

Methods: In this retrospective cohort study, 252 patients were included. The demographic data of all patients, including BMI, pre-operative uterine volumes, operation times, number of cesarean sections, history of lower abdominal operation, indications, pre-operative and postoperative hemoglobin differences, complications, length of hospital stay, and final pathologies were reviewed. The uterine volume was measured using the prolate ellipsoid formula before surgery, using the maximum length and anteroposterior and transverse diameters of the uterine corpus. The normal uterine volume with these measurements (8 cm long, 4 cm high, and 5 cm wide) was estimated as 83.2 cm³. The patients were classified into two groups according to uterine volume (normal volume ≤ 83.2 or above). Surgical outcomes of patients were compared between groups.

Results: Two-hundred-fifty-two women were included in the study. The mean uterine volumes of groups 1 and 2 were 53.66 cm³ (2.25) and 296.33 cm³(6.25), respectively. In group 1, the mean operation time was 111.14 (6) min, compared to 118.2 (3.06) min in group 2; there was no significant difference (P = 0.164). The mean postoperative hospital stays of groups 1 and 2 were 3.21 (0.15) and 3.34 (0.09) days, respectively, and there was no significant difference (P = 0.706). The mean blood loss values of groups 1 and 2 were 1.34 g/dl (0.19) and 1.16 g/dl 0.06), respectively.

Conclusion: According to our results, TLH is a safe method even in patients with a larger uterus; operating time, blood loss, and postoperative hospital stays did not differ according to uterine volume.

Downloads

Download data is not yet available.

References

Cheung VYT, Rosenthal DM, Morton M, Kadanka H. Total laparoscopic hysterectomy: a five-year experience. J Obstet Gynaecol Can. 2007;29(4):337-43. doi: 10.1016/S1701-2163(16)32429-X. PubMed PMID: 17475127. DOI: https://doi.org/10.1016/S1701-2163(16)32429-X

ACOG Committee Opinion No. 444: choosing the route of hysterectomy for benign disease. Obstet Gynecol. 2009;114(5):1156-8. doi: 10.1097/AOG.0b013e3181c33c72. PubMed PMID: 20168127. DOI: https://doi.org/10.1097/AOG.0b013e3181c33c72

Cohen SL, Vitonis AF, Einarsson JI. Updated hysterectomy surveillance and factors associated with minimally invasive hysterectomy. JSLS. 2014;18(3). doi: 10.4293/JSLS.2014.00096. PubMed PMID: 25392662; PubMed Central PMCID: PMC4208898. DOI: https://doi.org/10.4293/JSLS.2014.00096

O’Hanlan KA, McCutcheon SP, McCutcheon JG. Laparoscopic hysterectomy: impact of uterine size. J Minim Invasive Gynecol. 2011;18(1):85-91. doi: 10.1016/j.jmig.2010.09.016. PubMed PMID: 21195958. DOI: https://doi.org/10.1016/j.jmig.2010.09.016

Goldstein SR, Horii SC, Snyder JR, Raghavendra BN, Subramanyam B. Estimation of nongravid uterine volume based on a nomogram of gravid uterine volume: its value in gynecologic uterine abnormalities. Obstet Gynecol. 1988;72(1):86-90. PubMed PMID: 3288932.

Langer JE, Oliver ER, Lev-Toaff AS, Coleman BG. Imaging of the female pelvis through the life cycle. Radiographics. 2012;32(6):1575-97. doi: 10.1148/rg.326125513. PubMed PMID: 23065159. DOI: https://doi.org/10.1148/rg.326125513

Brummer TH, Jalkanen J, Fraser J, Heikkinen AM, Kauko M, Makinen J, et al. FINHYST, a prospective study of 5279 hysterectomies: complications and their risk factors. Hum Reprod. 2011;26(7):1741-51. Epub 20110503. doi: 10.1093/humrep/der116. PubMed PMID: 21540244. DOI: https://doi.org/10.1093/humrep/der116

Twijnstra AR, Blikkendaal MD, van Zwet EW, van Kesteren PJ, de Kroon CD, Jansen FW. Predictors of successful surgical outcome in laparoscopic hysterectomy. Obstet Gynecol. 2012;119(4):700-8. doi: 10.1097/AOG.0b013e31824b1966. PubMed PMID: 22395145. DOI: https://doi.org/10.1097/AOG.0b013e31824b1966

Koroglu N, Cetin BA, Turan G, Yildirim GY, Akca A, Gedikbasi A. Characteristics of total laparoscopic hysterectomy among women with or without previous cesarean section: retrospective analysis. Sao Paulo Med J. 2018;136(5):385-9. doi: 10.1590/1516-3180.2018.0197030718. PubMed PMID: 30570089. DOI: https://doi.org/10.1590/1516-3180.2018.0197030718

Seo ES, Lee SH, Chon SJ, Jung SY, Cho YJ, Lim S. Influence of previous abdominal surgery on clinical outcomes of patients undergoing total laparoscopic hysterectomy. Obstet Gynecol Sci. 2018;61(3):379-85. Epub 20180508. doi: 10.5468/ogs.2018.61.3.379. PubMed PMID: 29780781; PubMed Central PMCID: PMC5956122. DOI: https://doi.org/10.5468/ogs.2018.61.3.379

Otake A, Horai M, Tanaka E, Toda A, Miyoshi Y, Funada R, et al. Influences of Total Laparoscopic Hysterectomy According to Body Mass Index (Underweight, Normal Weight, Overweight, or Obese). Gynecol Minim Invasive Ther. 2019;8(1):19-24. Epub 20190123. doi: 10.4103/GMIT.GMIT_53_18. PubMed PMID: 30783584; PubMed Central PMCID: PMC6367909. DOI: https://doi.org/10.4103/GMIT.GMIT_53_18

Cianci S, Gueli Alletti S, Rumolo V, Rosati A, Rossitto C, Cosentino F, et al. Total laparoscopic hysterectomy for enlarged uteri: factors associated with the rate of conversion to open surgery. J Obstet Gynaecol. 2019;39(6):805-10. Epub 20190419. doi: 10.1080/01443615.2019.1575342. PubMed PMID: 31001998. DOI: https://doi.org/10.1080/01443615.2019.1575342

Terzi H, Hasdemir PS, Biler A, Kale A, Sendag F. Evaluation of the surgical outcome and complications of total laparoscopic hysterectomy in patients with enlarged uteruses. Int J Surg. 2016;36(Pt A):90-5. Epub 20161019. doi: 10.1016/j.ijsu.2016.10.024. PubMed PMID: 27770638. DOI: https://doi.org/10.1016/j.ijsu.2016.10.024

Kung FT, Chang SY. The relationship between ultrasonic volume and actual weight of pathologic uterus. Gynecol Obstet Invest. 1996;42(1):35-8. doi: 10.1159/000291886. PubMed PMID: 8840176. DOI: https://doi.org/10.1159/000291886

Gerges B, Mongelli M, Casikar I, Bignardi T, Condous G. Three-dimensional transvaginal sonographic assessment of uterine volume as a pre-operative predictor of need to morcellate in women undergoing laparoscopic hysterectomy. Ultrasound Obstet Gynecol. 2017;50(2):255-60. Epub 20170606. doi: 10.1002/uog.15991. PubMed PMID: 27281513. DOI: https://doi.org/10.1002/uog.15991