The four-trocar method for performing laparoscopically-assisted vaginal hysterectomy on large uteri.

STUDY OBJECTIVE

To assess the feasibility and efficacy of laparoscopically-assisted-vaginal hysterectomy (LAVH) for a large uterus with the new trocar technique.

DESIGN

Retrospective clinical study (Canadian Task Force classification III).

SETTING

University teaching hospital.

PATIENTS

Thirty-four women with a large uterus (>500 g).

INTERVENTION

LAVH with Choi's 4-trocar method.

MEASUREMENTS AND MAIN RESULTS

We reviewed the medical records of 34 patients for age, parity, history of previous abdominal surgery, operative indications, histopathologic diagnosis, mean operative time, weight of the removed uterus, change in the hemoglobin level, hospital stay, and occurrence of any complications. The patient's median age was 45 years (range 36-51 years), median parity was 2 (range 0-3), and 18 patients (52.9%) had a previous operative history. The most common operative indication was a palpable abdominal mass, and the most common histopathologic diagnosis was leiomyoma. The median operative time was 62.5 minutes (range 35-245 minutes), and the median weight of the removed uterus was 615.0 g (range 500-1200 g). The median change in hemoglobin level was 1.4 g/dL (range 0-5 g/dL). The median hospital stay was 4.0 days (range 2-6 days). The only complication was superficial port site bleeding (1 patient). None of the operations were switched to total abdominal hysterectomy.

CONCLUSION

Choi's 4-trocar method provided an excellent operative field during LAVH for a large uterus.