Specimen extraction techniques utilized in minimally invasive surgery for uterine cancer and an enlarged uterus: a quality assurance study.

This study was conducted to investigate the techniques and complications of enlarged uterine extraction during minimally invasive surgery for uterine malignancy. The electronic medical record was queried for patients with uterine malignancy and enlarged uterus (≥ 250 g) who underwent primary hysterectomy with laparoscopic or robotic approach. Statistical analysis was performed using Fisher's exact test for categorical variables and Kruskal-Wallis test for continuous variables. All patients with presumed uterine confined endometrial cancer who underwent upfront surgical management with minimally invasive hysterectomy and had uterine specimen weight ≥ 250 g were included. Seventy-eight patients met inclusion criteria. Mean specimen weight and mean operating time differed by extraction technique: intact vaginal extraction 307 g, 163 min; vaginal removal in specimen bag 337 g, 214 min; incidental vaginal morcellation 321 g, 178 min; vaginal morcellation in specimen bag 361 g, 212 min; and small laparotomy 677 g, 237 min. Specimens that required removal with small laparotomy incisions were larger in weight (p = < .001) and had increased operative time (p = < .001). Adjuvant treatment was given to 52.6% (41/78) of patients; 36.6% (15/41) received chemotherapy and 63.4% (26/41) received radiation. Rates of adjuvant radiation differed among extraction techniques (p = .018). Recurrence rates (n = 8) and patient death (n = 6) were not associated with extraction techniques (p = .408 and p = .537, respectively). Adjuvant radiation rates were statistically different among extraction techniques. Specimens removed by small laparotomy were significantly larger and required greater operative time. This study demonstrated that minimally invasive surgery was feasible in patients with uterine malignancy and an enlarged uterus.