Objective: To examine the safety and feasibility of laparoscopically assisted vaginal hysterectomy (LAVH) for uteriweighing 500 g or more as compared to uteri weighing less than 500 g in the management of benign gynec...Objective: To examine the safety and feasibility of laparoscopically assisted vaginal hysterectomy (LAVH) for uteriweighing 500 g or more as compared to uteri weighing less than 500 g in the management of benign gynecological diseases. Me thod: In this prospective comparative study, 189 women with different benign gyn ecological diseases were scheduled for laparoscopically assisted vaginal hystere ctomy. They were divided into two groups, with uterine weight greater than 500 g and uterine weight less than 500g. Outcome measures for both the groups were st udied comparatively in terms of length of operative time, amount of blood loss, requirement of blood transfusion and length of hospital stay. Results: Length of operation and amount blood loss were significantly greater in the uteri ≥500 g group than in the < 500 g at 91.1±28.7 min versus 77.4±26.6 min (P< 0.01), an d 570.5±503.6 ml versus 262.5±270.0 ml (P< 0.001), respectively. However, ther e was no difference in length of hospital stay and overall incidence of operativ e complications between the two groups. None of the women had any major complica tions though 17 minor complications were noted. There was no incidence of switch ing to abdominal laparatomy during the operation except for one patient who requ ired “minilaparotomy”for removal of large surgical specimen (2400 g). Extreme intra-operative hemorrhage of more than 1000 ml occurred in five patients, howe ver, they made full recovery after blood transfusion. Rate of blood transfusion was significantly lower in the uteri < 500 g group (4.8%versus 34.9%, P < 0.00 1). Conclusion: This study demonstrates that despite the increased operating tim e and blood loss, LAVH can be safely performed for large uterus. However, surgeo ns need to be aware of the high risk of blood transfusion in these patients.展开更多
文摘Objective: To examine the safety and feasibility of laparoscopically assisted vaginal hysterectomy (LAVH) for uteriweighing 500 g or more as compared to uteri weighing less than 500 g in the management of benign gynecological diseases. Me thod: In this prospective comparative study, 189 women with different benign gyn ecological diseases were scheduled for laparoscopically assisted vaginal hystere ctomy. They were divided into two groups, with uterine weight greater than 500 g and uterine weight less than 500g. Outcome measures for both the groups were st udied comparatively in terms of length of operative time, amount of blood loss, requirement of blood transfusion and length of hospital stay. Results: Length of operation and amount blood loss were significantly greater in the uteri ≥500 g group than in the < 500 g at 91.1±28.7 min versus 77.4±26.6 min (P< 0.01), an d 570.5±503.6 ml versus 262.5±270.0 ml (P< 0.001), respectively. However, ther e was no difference in length of hospital stay and overall incidence of operativ e complications between the two groups. None of the women had any major complica tions though 17 minor complications were noted. There was no incidence of switch ing to abdominal laparatomy during the operation except for one patient who requ ired “minilaparotomy”for removal of large surgical specimen (2400 g). Extreme intra-operative hemorrhage of more than 1000 ml occurred in five patients, howe ver, they made full recovery after blood transfusion. Rate of blood transfusion was significantly lower in the uteri < 500 g group (4.8%versus 34.9%, P < 0.00 1). Conclusion: This study demonstrates that despite the increased operating tim e and blood loss, LAVH can be safely performed for large uterus. However, surgeo ns need to be aware of the high risk of blood transfusion in these patients.
