Obstet Gynecol Sci.  2020 Apr;63(3):379-386. 10.5468/ogs.2020.63.3.379.

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

• Oh SJ
• Lee SY
• Kim WY
• Kang J
• Han KH
• Lee SH
• Park JS

• KMID: 2500429
• DOI: http://doi.org/10.5468/ogs.2020.63.3.379

Abstract

Objective
To 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).
Methods
A 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.
Results
Perioperative 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).
Conclusion
TUM 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.

Keyword

Adenomyosis; Hysterectomy; Laparoscopy; Minimally invasive surgical procedures; Myoma

Figure

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  Fig. 1 Umbilicus wound (A) before starting laparoscopy, (B) after the end of operation.

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  Fig. 2 Single-port channel system.

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  Fig. 3 Tissue extraction through umbilicus.

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