Nathan Mordel, M.D. »Janet Lefkowitz, D.O. »

Hysterectomy for Large Uteri

Patients undergoing laparoscopic or robotically assisted laparoscopic (minimally invasive) surgery recover faster, enjoy superior cosmetic outcome, have less pain and less blood loss as compared to laparotomy (traditional, open) surgery. This is true for hysterectomies (removal of uterus with or without cervix) as well.

Robotically assisted total laparoscopic hysterectomy (RATLH) stands for the removal of uterus and cervix. Robotically assisted laparoscopic supracervical hysterectomy (RALSH) stands for the removal of uterus with preservation of the cervix. Both RATLH and RALSH are outpatient surgeries (no need for overnight hospital stay).

What Constitutes a Large Uteri?

A normal size uterus weighs one to two ounces. Uterine sizes are defined in comparison to pregnant uterus. Most commonly uteri grow in size due to enlarging fibroids. A “three months (12 weeks) pregnancy” size uterus weighs about one half of a pound. A “four months (16 weeks) pregnancy” size uterus weighs about one and a half pounds. A “five months (20 weeks) pregnancy” size uterus weighs about three pounds. A “six months (24 weeks) pregnancy” size uterus weighs about four to five pounds.

Choosing a Minimally Invasive Gynecologic Surgeon

Performing RATLH or RALSH on larger uteri requires a highly skilled minimally invasive gynecologic surgeon. The larger the uterus, the more challenging is the RATLH or RALSH. A very experienced surgeon can safely remove uteri weighing several pounds still using minimally invasive techniques such as RATLH or RALSH.

Large uteri are usually distorted by large fibroids. This in turn significantly alters adjacent pelvic anatomy causing difficulty in its proper recognition. It is more difficult to manipulate a large uterus and it is harder to employ the different operative instruments.

Usually, three quarters of an inch (20mm) diameter morcellators are used to remove large uteri. Again, this requires higher expertize as compared to removal of small uteri using smaller morcellators.

If a surgeon is not experienced enough, then higher blood loss or complications, such as injuries to the bowel, bladder or ureters may occur at a higher rate. Alternatively, a less experienced surgeon may decide to convert to laparotomy in the middle of the operation.

Patients in a need for RATLH or RALSH and are afflicted with large uteri should choose an experienced surgeon.

The key questions to ask a surgeon are:

  • How large the uteri has he/she removed?
  • How many of these uteri has he/she removed?
  • What is his/her complication rate?
  • What is his/her conversion rate?
  • What is his/her transfusion rate?


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