Feasibility and safety of total laparoscopic retrograde hysterectomy in a large uterus with obliterated cul-de-sac due to severe endometriosis

OBJECTIVE: To examine the safety and feasibility of total laparoscopic retrograde hysterectomy (TLreH) in patients with obliterated cul-de-sac due to severe endometriosis. STUDY DESIGN: This retrospective case-control observational study was performed at the Yokohama Municipal Citizen's Hospital between January 2014 and December 2019. Ninety-two women who underwent TLreH and who had uterine fibroids, adenomyosis, or both with obliterated cul-de-sac due to severe endometriosis were enrolled. RESULTS: Surgical outcomes were retrospectively analyzed. The median operation time was 122 (range, 54-312) min, and the median blood loss was 150 (range, 0-1420) mL. Perioperative complications (Clavien-Dindo classification ≥Ⅲ) occurred in 3 cases (3.3 %). There were no cases of transition to open surgery. Blood transfusion was required in 1 case. The operation time and estimated blood loss volume were significantly correlated with the weight of the uterus (p < 0.01). The subjects were divided into two groups: uteri weighing ≥600 g group and those weighing <600 g group. In the ≥600 g group, the median operation time and median estimated blood loss volume were 130 (81-312) min and 265 (70-1420) mL, respectively. There was no difference in the frequency of perioperative complications or blood transfusions between the groups. CONCLUSION: Our study demonstrated that TLreH for severe endometriosis with obliterated cul-de-sac was feasible and safe. It could be safely performed for large uteri (≥600 g) with obliterated cul-de-sac due to severe endometriosis.