Laparoscopic Single-Incision Supracervical Hysterectomy for an Extremely Large Uterus with Bag Tissue Extraction

Abstract

Objective: To describe and demonstrate the single-incision laparoscopic technique with an articulated energy device for a uterus larger than 20 cm.

Design: Stepwise demonstration of the single-site surgical technique and tissue extraction with narrated video footage (Canadian Task Force classification III).

Setting: Single-incision laparoscopic hysterectomy can be difficult because of the long operating time, steep learning curve, and need for articulated instruments, and it is especially challenging in patients with a uterus larger than 20 cm. However, the advantages of single-site laparoscopic surgery may include less bleeding, infection, and pain and a better cosmetic outcome.

Interventions: A 49-year-old G3P3 female with a 24 weeks-sized fibroid uterus requesting supracervical hysterectomy presented to our tertiary academic medical center with a 2-year history of pelvic pain and menorrhagia with a normal Pap smear history. Uterine weight was 1900 g. Laparoscopic single-incision supracervical hysterectomy with contained bag tissue extraction was performed. Rotating between the patient's right and left side allowed the surgeon to access the entire abdomen from a single umbilical port. There was no complications or conversions to multiport in the surgery.

Conclusion: Single-incision laparoscopic hysterectomy for a uterus larger than 20 cm is possible and leads to better outcomes.

Keywords: Contained bag tissue extraction; Laparoscopic; Single site; Supracervical hysterectomy.