Laparoscopic-assisted vaginal hysterectomy of large myomatous uteri with supracervical amputation followed by trachelectomy.

Since most abdominal hysterectomies are performed for treatment of large uterine fibroids, an effective laparoscopic approach must be discovered for the endoscopic treatment of large uterine fibroids. We performed a retrospective analysis of all laparoscopic-assisted vaginal hysterectomies (LAVHs) we performed on uteri that were both greater than 12 weeks' size on preoperative examination and heavier than 450 g on pathologic evaluation. Twenty cases fulfilled the selection criteria, with mean uterine weight of 709 g and operating time of 178 minutes. Two surgical approaches were compared. Group 1 (5 women) consisted of LAVH without supracervical amputation with mean operating time of 216 minutes. Group 2 (15 women) consisted of laparoscopic supracervical amputation followed by vaginal trachelectomy with mean operating time of 165 minutes. Our results suggest that laparoscopic supracervical amputation can enhance the laparoscopic management of large uterine fibroids.