초록 열기/닫기 버튼
ObjectiveTo compare the perioperative outcomes of transumbilical morcellation (TUM) and transvaginal morcellation (TVM) ofa large uterus (≥500 g) during single-port-access total laparoscopic hysterectomy (SPA-TLH). MethodsA total of 57 patients who underwent SPA-TLH for a large uterine myoma and/or adenomyosis (uterine weight ≥500 g)between March 2013 and July 2017 were included. For specimen retrieval, TUM was performed for 30 patients andTVM for 27 patients. ResultsPerioperative outcomes, including total operative time, tissue extraction time, extension of skin incision length,estimated volume of blood loss, changes in postoperative hemoglobin level, length of postoperative hospitalstay, postoperative pain, and uterine weight, were compared between the 2 groups. No significant differenceswere observed in the baseline characteristics except for a history of cesarean section (TUM vs. TVM: 83.3% vs. 14.8%, P=0.002) and history of vaginal delivery (TUM vs. TVM: 6.7% vs. 88.8%, P=0.001). The total operative time,tissue extraction time, extension of skin incision length, estimated volume of blood loss, changes in postoperativehemoglobin level, length of postoperative hospital stay, and postoperative pain did not significantly differ betweenthe two groups. The uterine weight was significantly higher for patients who underwent TUM than for those whohad TVM (median [range]: 735 g [520–1,380 g] vs. 622 g [514–975 g]; P=0.042). ConclusionTUM during SPA-TLH is a feasible technique for extracting large uteri weighing ≥500 g. This procedure is suitable forpatients without a history of vaginal delivery or a narrow vaginal cavity.
