Single port access laparoscopic-assisted vaginal hysterectomy for large uterus weighing exceeding 500 grams: technique and initial report

STUDY OBJECTIVE: To present our initial experience with single-port access laparoscopic-assisted vaginal hysterectomy (SPA-LAVH) in a large uterus weighing in excess of 500 g. DESIGN: A prospective single-center study (Canadian Task Force classification III). SETTING: University hospital PATIENTS: Fifteen patients with an extirpated uterine weight of more than 500 g were enrolled from May 2008 to September 2009. INTERVENTIONS: SPA-LAVH. MEASUREMENTS AND MAIN RESULTS: There were 11 cases with uterine myomas and 4 cases of adenomyosis. All patients had symptoms related to these diagnoses including menorrhagia, dysmenorrhea, and pelvic pressure symptoms such as urinary frequency. The median and range are used to describe data not distributed normally. The median operation time, weight of the uterus, and estimated blood loss were 125 minutes (80 to 236 minutes), 690 g (503 to 1260 g), and 500 mL (150 to 1000 mL), respectively. There was a significant linear correlation between the operation time and the extirpated uterine weight (p<.002). Thirteen procedures were successfully performed with SPA-LAVH. The SPA procedure failed in 2 cases: 1 (uterine weight, 732 g) required 1 ancillary 5-mm port to manipulate with a myoma screw, and in the other we inserted 1 additional 15-mm port to use for a laparoscopic morcellator. There were no umbilical complications, additional procedures, or surgical complications. CONCLUSION: The SPA-LAVH procedure for a large uterus weighing in excess of 500 g was as safe and effective as the conventional LAVH. Additional experience and continued investigation are warranted.