Total Laparoscopic Hysterectomy for Large Uteri weighing more than 500 grams at a Single Institution

Shiro Takamatsu, Motonori Matsubara, Toshimichi Onuma, Takahiro Tsuji, Kimihisa Tajima, Hayato Shimada
In: JAPANESE JOURNAL OF GYNECOLOGIC AND OBSTETRIC ENDOSCOPY · 2014 · vol. 30(1) , pp. 169–176 · doi:10.5180/jsgoe.30.169 · W2322297305
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⚙ AI-generated summary by claude@2026-06, 2026-06-09 ⓘ

Total laparoscopic hysterectomy for uteri weighing over 500 grams resulted in greater blood loss, longer surgery times, and higher conversion rates but no increased risk of postoperative complications compared to smaller uteri.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-09 · read from full text ⓘ

This retrospective single-institution study evaluated the feasibility of total laparoscopic hysterectomy (TLH) for large uteri by comparing 32 women with uterine weights >500 g (Group A) to 124 women with uterine weights <500 g (Group B) who underwent TLH from 2009–2014 for symptomatic uterine leiomyomas and/or adenomyosis. Group A had significantly greater intraoperative blood loss and longer surgery times than Group B, and conversion to laparotomy occurred more often (9.4% vs. 0.8%). Postoperative outcomes showed no significant difference in overall complications or major complications requiring further treatment between groups. The paper is relevant to adenomyosis because the included TLH patients had symptomatic uterine leiomyomas and/or adenomyosis, and the study’s feasibility outcomes apply to this adenomyosis population, though the main focus is uterine size (>500 g).

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Abstract

Objective: To investigate the feasibility of a total laparoscopic hysterectomy (TLH) for large uteri weighting over 500 g.Design: Retrospective analysis.Setting: Department of Obstetrics and Gynecology, Fukui Red Cross Hospital, Japan.Patients: A total of 156 women who underwent a TLH from 2009 through 2014 for symptomatic uterine leiomyomas and/or adenomyosis at our institution were divided into two groups based on uterine weight: > 500 g (Group A; n = 32) and < 500 g (Group B; n = 124). Outcome measures were evaluated by comparison of the two groups in regard to patient characteristics, surgical outcomes, rates of conversion to laparotomy, and complications.Results: Intraoperative blood loss and surgery time were significantly greater in Group A than Group B (blood loss: 325 ± 550 ml vs. 123 ± 175 ml; surgery time: 246 ± 50 min vs. 183 ± 44 min; P < 0.05). Rate of conversion to laparotomy was significantly higher in group A than Group B (9.4% vs. 0.8%; P < 0.05). There were no significant differences in the incidence of total postoperative complications (9.4% vs. 5.6%) or major postoperative complications that required further treatment (3.1% vs. 3.2%).Conclusions: Despite the increased intraoperative blood loss, surgery time, and rate of conversion to laparotomy, a TLH for a large uterus (> 500 g) can be performed without an increased risk of post-operative complications. However, surgeons have to be proficient with specific surgical approaches for a large uterus and be aware of the potential risk of conversion to laparotomy.
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Objective

To investigate the feasibility of a total laparoscopic hysterectomy (TLH) for large uteri weighting over 500 g. Design: Retrospective analysis. Setting: Department of Obstetrics and Gynecology, Fukui Red Cross Hospital, Japan. Patients: A total of 156 women who underwent a TLH from 2009 through 2014 for symptomatic uterine leiomyomas and/or adenomyosis at our institution were divided into two groups based on uterine weight: > 500 g (Group A; n = 32) and < 500 g (Group B; n = 124). Outcome measures were evaluated by comparison of the two groups in regard to patient characteristics, surgical outcomes, rates of conversion to laparotomy, and complications.

Results

Intraoperative blood loss and surgery time were significantly greater in Group A than Group B (blood loss: 325 ± 550 ml vs. 123 ± 175 ml; surgery time: 246 ± 50 min vs. 183 ± 44 min; P < 0.05). Rate of conversion to laparotomy was significantly higher in group A than Group B (9.4% vs. 0.8%; P < 0.05). There were no significant differences in the incidence of total postoperative complications (9.4% vs. 5.6%) or major postoperative complications that required further treatment (3.1% vs. 3.2%).

Conclusions

Despite the increased intraoperative blood loss, surgery time, and rate of conversion to laparotomy, a TLH for a large uterus (> 500 g) can be performed without an increased risk of post-operative complications. However, surgeons have to be proficient with specific surgical approaches for a large uterus and be aware of the potential risk of conversion to laparotomy. Design: Retrospective analysis. Setting: Department of Obstetrics and Gynecology, Fukui Red Cross Hospital, Japan. Patients: A total of 156 women who underwent a TLH from 2009 through 2014 for symptomatic uterine leiomyomas and/or adenomyosis at our institution were divided into two groups based on uterine weight: > 500 g (Group A; n = 32) and < 500 g (Group B; n = 124). Outcome measures were evaluated by comparison of the two groups in regard to patient characteristics, surgical outcomes, rates of conversion to laparotomy, and complications.

Results

Intraoperative blood loss and surgery time were significantly greater in Group A than Group B (blood loss: 325 ± 550 ml vs. 123 ± 175 ml; surgery time: 246 ± 50 min vs. 183 ± 44 min; P < 0.05). Rate of conversion to laparotomy was significantly higher in group A than Group B (9.4% vs. 0.8%; P < 0.05). There were no significant differences in the incidence of total postoperative complications (9.4% vs. 5.6%) or major postoperative complications that required further treatment (3.1% vs. 3.2%).

Conclusions

Despite the increased intraoperative blood loss, surgery time, and rate of conversion to laparotomy, a TLH for a large uterus (> 500 g) can be performed without an increased risk of post-operative complications. However, surgeons have to be proficient with specific surgical approaches for a large uterus and be aware of the potential risk of conversion to laparotomy. © 2014 日本産科婦人科内視鏡学会

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adenomyosis

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