Publications

Objective: Our objective was to identify predictors of morcellation during total laparoscopic hysterectomy (TLH) DESIGN: Retrospective cohort study (Canadian Task Force classification II-2) SETTING: University Hospital Center in XXX PARTICIPANTS: Women undergoing a TLH for a benign gynecologic pathology form January 1st 2017 to January 31st 2019 INTERVENTION: All women underwent a TLH. If the uterus was to voluminous to be removed vaginally, surgeons favored in-bag morcellation by laparoscopy. Uterine weight and characteristics were assessed prior to surgery by ultrasound or MRI in order to predict morcellation.

Main results: A total of 252 women underwent a TLH and the mean age was 46±7 (30-71) years old. The main indications for surgery were abnormal uterine bleeding (77%), chronic pelvic pain (36%) and bulk symptoms (25%). Mean uterine weight was 325 (17-1572)±272 grams, with 11/252 (4%) uterus being >1000 grams and 71% of women had at least one leiomyoma. Among women with a uterine weight <250 grams, 120 (95%) did not require morcellation. On the opposite, among women with a uterine weight >500 grams, 49 (100%) required morcellation. In addition to the estimated uterine weight (≥250 versus <250 grams; OR 3.7 (CI 1.8-7.7, P < 0.01), having ≥ 1 leiomyoma (OR 4.1, CI 1.0-16.0, P = 0.01) and a leiomyoma of ≥5 cm (OR 8.6, CI 4.1-17.9, P < 0.01) were other significant predictors morcellation in multivariate logistic regression analysis.

Conclusion: Uterine weight estimated by preoperative imaging as well as the size and number of leiomyomas are useful predictors of the need for morcellation.

Keywords: hysterectomy; laparoscopy; morcellation; predictive factors.