Operating time and blood loss during laparoscopic-assisted vaginal hysterectomy with in situ morcellation

Abstract

Objective: To develop a regression-based prediction equation for operative time and estimated blood loss in laparoscopically assisted vaginal hysterectomy (LAVH) for large uteri, as required, by combined laparoscopic in situ and vaginal morcellation.

Design: Prospective study (Canadian Task Force classification II-1).

Setting: University-affiliated hospitals.

Sample: Fifty-six patients who underwent LAVH. Methods. Evaluation of all patients who had LAVH with laparoscopic in situ morcellation and vaginal morcellation during a 2-year period.

Main outcome measures: Operative time, estimated blood loss, total uterine weight by laparoscopic or vaginal morcellation, complications and length of hospital stay.

Results: Mean operative time was 133 ± 22 minutes, and mean blood loss 133 ± 101 ml. Mean uterine weight was 383 ± 187 g by laparoscopic and 251 ± 103 g by vaginal morcellation. Greater total uterine weight and morcellation were associated with longer operative times. Blood loss correlated with uterine weight when vaginal morcellation was also used. A regression equation is presented for estimating the likely operating time and blood loss.

Conclusions: An increase in the operative time and a higher blood loss can be expected as the uterine weight increases and can be predicted taking morcellation methods into account.