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Minerva Ginecologica 2020 Jul 17

DOI: 10.23736/S0026-4784.20.04602-X


lingua: Inglese

Association of uterine dimensions and route of contained morcellation following laparoscopic hysterectomy

Aakriti R. CARRUBBA 1 , Alfredo J. JIJON 1, Michael G. HECKMAN 2, Danielle E. BRUSHABER 3, Anita H. CHEN 1, Tri A. DINH 1, Christopher C. DESTEPHANO 1

1 Department of Gynecologic Surgery, Mayo Clinic Florida, Jacksonville, FL, USA; 2 Division of Biomedical Statistics and Informatics, Mayo Clinic Florida, Jacksonville, FL, USA; 3 Division of Biomedical Statistics and Informatics, Mayo Clinic Florida, Rochester, MN, USA


BACKGROUND: To determine if uterine dimensions on pre-operative imaging are associated with route of contained morcellation during laparoscopic hysterectomy.
METHODS: This is a prospective cohort study of patients undergoing laparoscopic hysterectomy and requiring morcellation for specimen extraction from March 2017 through August 2019. A contained extraction system was inserted, and manual morcellation was performed vaginally, abdominally, or via a combination of both methods in cases of failed vaginal extraction.
RESULTS: A total of 47 patients were treated. Median age was 47 (range 38 - 70). Morcellation was performed vaginally for 29 patients (61.7%), abdominally for 13 patients (27.7%), and via combined approach for 5 patients (10.6%). The combined group had the highest frequency of patients who were black (vaginal: 24%, abdominal: 31%, combined: 100%; p=0.005), the longest median total operating time (vaginal: 167 minutes, abdominal: 183 minutes, combined: 268 minutes; p=0.006), and the longest median time of uterine morcellation (vaginal: 14 minutes, abdominal: 37 minutes, combined: 85 minutes; p<0.001). There was strong evidence of a positive correlation with time of uterine morcellation for both largest uterine diameter (Spearman’s r: 0.62, P<0.001) and uterine volume (Spearman’s r: 0.70, P<0.001). These associations remained consistent after multivariable linear regression models that were adjusted for route of morcellation, hysterectomy type, and BMI (both P<0.001).
CONCLUSIONS: Larger uterine dimensions are associated with increased total operating and morcellation times. Uterine size and volume on pre-operative imaging were not associated with route of morcellation, but there was a trend towards failed vaginal extraction when uterine dimensions exceeded 16 centimeters.

KEY WORDS: Uterine morcellation; Leiomyomas; Minimally invasive hysterectomy; Contained morcellation; Surgical proficiency

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