Department of Gynecologic Oncology, Azienda Ospedaliera Brotzu, Via Jenner, 09100, Cagliari, Italy.
Department of Pathology, Azienda Ospedaliera Brotzu, Cagliari, Italy.
Arch Gynecol Obstet. 2021 Jan;303(1):169-179. doi: 10.1007/s00404-020-05799-6. Epub 2020 Sep 19.
To assess the feasibility and safety of total laparoscopic hysterectomy (TLH) for uteri ≥ 1.5 kg.
We prospectively evaluated all elective TLHs (with or without adnexectomy) performed for fibromatous uteri between August 2009 and August 2019 in the Department of Obstetrics and Gynecology, Sirai Hospital, Carbonia, and the Department of Gynecologic Oncology, Businco Hospital, Azienda Ospedaliera Brotzu, Cagliari. Patients with large myomatous uteri (uterine weight ≥ 1.5 kg on pathology reports) were included in the analysis. We examined all procedures and collected data about intra- and post-operative short-term and long-term complications, intraoperative blood loss, operative time, hospital stay, and time to achieve well-being.
Seventy-eight patients were included. The median weight was 2,000 g (range 1,500-11,000 g), estimated blood loss was 100 mL (range 10-700 mL), operating time was 135 min (range 60-300 min), and hospital stay was 2 days (range 2-5 days). Conversion to laparotomy occurred in 4 patients (5.1%) with uterine weight ranging from 3 to 5.5 kg, due to severe adherence syndrome or inadequate visualization. As for intraoperative complications, 1 patient (who had the largest removed uterus weighing 11,000 g) experienced an intraoperative ureteral injury (grade III). No major postoperative complications occurred.
This study provides the largest case series of TLH for fibromatous uteri > 1.5 kg and includes some of the largest uteri reported to date in the literature (weighing 5,320, 5,720, and 11,000 g, respectively). The study reaffirms the feasibility and safety of a minimally invasive hysterectomy even in the case of abnormally large uteri.
评估经腹腔镜全子宫切除术（TLH）治疗子宫重量≥1.5kg 的子宫纤维瘤的可行性和安全性。
我们前瞻性评估了 2009 年 8 月至 2019 年 8 月在卡利亚里的锡拉伊医院妇产科和布西诺医院妇科肿瘤科进行的所有择期 TLH（伴或不伴附件切除术），这些手术均为纤维瘤子宫。包括分析子宫重量大（病理报告中子宫重量≥1.5kg）的患者。我们检查了所有的手术程序并收集了术中、术后短期和长期并发症、术中出血量、手术时间、住院时间和恢复健康的时间等数据。
共纳入 78 例患者。中位子宫重量为 2000g（范围 1500-11000g），估计出血量为 100mL（范围 10-700mL），手术时间为 135min（范围 60-300min），住院时间为 2 天（范围 2-5 天）。4 例（5.1%）患者因严重粘连综合征或可视性差而转为开腹手术，子宫重量为 3-5.5kg。术中并发症方面，1 例（切除最大子宫重 11000g）患者发生术中输尿管损伤（III 级）。无重大术后并发症发生。
本研究提供了最大的经腹腔镜治疗纤维瘤子宫重量>1.5kg 的病例系列，包括一些文献报道的迄今为止最大的子宫（分别重 5320g、5720g 和 11000g）。该研究再次证实了微创子宫切除术的可行性和安全性，即使是在子宫异常大的情况下。
