Comparison between transumbilical and transvaginal morcellation of a large uterus during single-port-access total laparoscopic hysterectomy

Obstetrics & Gynecology Science

Woo Yong Kim¹  Seung Ju Oh²  Kyoung-Hee Han²  Jieun Kang²  Seo Young Lee²  San-Hui Lee²  Ji Sun Park² 

[1] Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, .Korea;Department of Obstetrics and Gynecology, Yonsei University Wonju College of Medicine, Wonju, .Korea;

关键词: adenomyosis;    hysterectomy;    laparoscopy;    minimally invasive surgical procedures;    myoma;   

DOI  :  10.5468/ogs.2020.63.3.379

来源: DOAJ

【 摘 要 】

ObjectiveTo compare the perioperative outcomes of transumbilical morcellation (TUM) and transvaginal morcellation (TVM) of a large uterus (≥500 g) during single-port-access total laparoscopic hysterectomy (SPA-TLH).MethodsA total of 57 patients who underwent SPA-TLH for a large uterine myoma and/or adenomyosis (uterine weight ≥500 g) between March 2013 and July 2017 were included. For specimen retrieval, TUM was performed for 30 patients and TVM for 27 patients.ResultsPerioperative outcomes, including total operative time, tissue extraction time, extension of skin incision length, estimated volume of blood loss, changes in postoperative hemoglobin level, length of postoperative hospital stay, postoperative pain, and uterine weight, were compared between the 2 groups. No significant differences were observed in the baseline characteristics except for a history of cesarean section (TUM vs. TVM: 83.3% vs. 14.8%, P=0.002) and history of vaginal delivery (TUM vs. TVM: 6.7% vs. 88.8%, P=0.001). The total operative time, tissue extraction time, extension of skin incision length, estimated volume of blood loss, changes in postoperative hemoglobin level, length of postoperative hospital stay, and postoperative pain did not significantly differ between the two groups. The uterine weight was significantly higher for patients who underwent TUM than for those who had TVM (median [range]: 735 g [520–1,380 g] vs. 622 g [514–975 g]; P=0.042).ConclusionTUM during SPA-TLH is a feasible technique for extracting large uteri weighing ≥500 g. This procedure is suitable for patients without a history of vaginal delivery or a narrow vaginal cavity.

【 授权许可】

Unknown