Estimate A Rational Cutoff Value Of Uterine Size For Laparoscopic Assisted Transvaginal Hysterectomy (LAVH)

Objective: Estimate a rational cutoff value of uterine size for laparoscopic assisted transvaginal hysterectomy ( LAVH ) Methods: A total of 488 patients received LAVH were retrospectively studied between January 2003 and July 2006. According to their uterine size, they were divided into 4 groups: group 1 (the uterus was not enlarged than 8 gestational weeks, 282 cases ), group 2 (the uterus was enlarged as 9-12 gestational weeks, 162 cases ), group 3 (the uterus was enlarged as 13-16 gestational weeks, 32 cases ) and group 4 (the uterus was enlarged as 17-20 gestational weeks, 12 cases ). The operative time, estimated blood loss, highest postoprative temperature, the time of anus regain to evacuate and duration of hospital stay were compared. Results: The differences of highest postoprative temperature, the time of anus regain to evacuate and duration of hospital stay according to the group were not significant statistically (P >0.05), whereas which of the operative time and estimated blood loss were very significant statistically(P <0.01): ( group 1: operative time 118.55 ± 31.36min, estimated blood loss 150.32 ± 81.43ml, highest postoprative temperature 37.66 ± 0.30℃, the time of anus regain to evacuate 25.38 ±7.42h and duration of hospital stay 4.23 ±1.11d; group 2 : 126.36 ±31.30min, 180.22 ±89.72ml, 37.66 ± 0. 28℃, 25.52± 7.67h, 4.06± 1.20d; group 3 : 139.69 ± 35.71min, 200.00±106.26ml, 37.64 ± 0.26℃, 23.19 ± 6.86h, 4.00 ± 0.72d; group 4 : 166.67± 7.49min, 316.67±93.744ml, 37.55 ± 0. 11℃, 27.08± 2.39h, 4.33 ± 0.78d). The operative time and estimated blood loss increased gradually along with the uterine enlargement. Positive correlations between uterine size and operative time and estimated blood loss could be seen ( operative time-groups: r = 0.20, P<0.01; estimated blood loss-groups: r = 0.21, P<0.01).Once the uterus was larger than 16 gestational weeks, the two indexes increased hurriedly.Conclusion: The rational cutoff value of uterine size for LAVH might be 16 gestational weeks.