Hüseyin KIYAK, Onur KARAASLAN, Kerem SEÇKİN, Tolga KARACAN, Eser Sefik OZYUREK, Gulseren YILMAZ, Berk BULUT

Preoperative Factors Associated with the Need for the Morcellation in Total Laparoscopic Hysterectomy

Removal of uterus during laparoscopic hysterectomy (LH) is occasionally challenging and therefore sometimes requires morcellation. Morcellation techniques for hysterectomy can spread the cancer cells which were presumed benign preoperatively in to the abdomen or pelvis. Probability of an undetected malignity should not be disregarded and accordingly must be shared with the patient prior to LH. The present study aimed to identify the demographic and the clinical factors associated with the need for morcellation in patients undergoing LH. A total of 153 patients who underwent LH for presumed benign causes were enrolled in this retrospective study. Subjects were divided into two groups according to the need for the morcellation during the LH: Morcellation group and intact vaginal removal (IVR) group (it was possible to deliver the uterine specimen vaginally). The two groups were compared with respect to demographic and clinical characteristics, indications for LH, preoperative ultrasonographic findings and postoperative complications. The frequency of the postmenopausal women was significantly higher in the morcellation group than the IVR group (p = 0.005). Preoperative uterus width (p < 0.001) and postoperative Uterus weight (p < 0.001) were significantly higher in the morcellation group compared to that of the IVR group. There were no significant differences between the groups regarding the complication rate. Uterine weight (OR: 1.020, 95 % CI: 1.008-1.031, p = 0.001) and menopause (OR: 2.571, 95 % CI: 1.328-4.980, p < 0.001) were predictive for the need of morcellation. A cut-off value of 287.5 gram was able to predict the need for morcellation with 87% sensitivity and 71 % specificity. The present study demonstrates that uterine weight and presence of the menopause are predictive for the need of morcellation at the time of the total LH. These factors should be considered in preoperative planning and used to further guide surgeons in providing LH.

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