1. TEMPLATE DESIGN © 2008 www.PosterPresentations.com Major surgery in a minor way Sin WT, Woldman S, Attilia B, Gauthaman N, Karpouzis H, Patwardhan M South London Health Care NHS trust Introduction Methods We carried out a retrospective analysis of all patients who underwent a laparoscopic subtotal hysterectomy under one surgeon at the South London Health Care NHS trust. Data were collected between 2009 and 2011. All patients with a uterus which clinically measured as ≥16weeks in size were selected. Those with a uterus weight of ≥240gms confirmed on histology were then included in the study. Data was collected for: Intra-operative complications, operation duration, estimated blood loss and length of hospital stay, which includes the time the patient is admitted to the time she is discharged. Results 53 patients were included in our study, 52 patients had successful LSH and one patient was converted to AH due to a large broad ligament fibroid (775g). Mean weight of the uterus was 467g [%] (245 to 410g: 28 [53%], 450 to 649g: 13 [25%], 650 to 849g: 7 [13%], 850 to 1400g: 5 [9%]). Mean operation time was 83.83minutes (40 to 117minutes). In all cases, 3 ports entry technique were used with the primary port being supra-umbilical There were no significant major intra-operative complications recorded. 52 (98.1%) patients had insignificant blood loss and 1 (1.8%) had significant blood loss requiring blood transfusion. Mean hospital stay was 1.45 days (1 day: 36 [67.9%], 2 days:12 [22.6%], 3 days: 3 [5.6%], 4 days: 2 [3.8%]). Discussion References In the case of large uterine fibroids, LSH provide a safe and better alternative to TLH and AH. 1. Nice guideline: IPG239 Laparoscopic techniques for hysterectomy September 2010 2. Nice guideline: Hysterectomy service, commissioning guide December 2007 3. Reich H, Roberts T. Laparoscopic hysterectomy in current gynaecological practice. Rev Gynaecol Prac. 2003;3:32 4. Image A, B – Ethicon endo surgery 5. Image C – Patwardhan, LSH 2012 Hysterectomy is one of the most common gynaecology operations performed in the UK. The standard benchmark rate of hysterectomies in a primary health care trust is 179 per year (assuming a 125,000 female population and a hysterectomy rate of 0.143% per year) 1 It is often the chosen treatment option for symptomatic large fibroid uterus that has not responded to conservative or medical treatment. Current evidence on the safety and efficacy of laparoscopic techniques for hysterectomies is supportive of its use. 2 However, in cases of large fibroid uterus, the size of the uterus is frequently considered the limiting factor when deciding whether laparoscopic technique is most suitable. Laparoscopic supra-cervical hysterectomy ( LSH) is recognised as one of the more advanced gynaecological minimal access procedures and specialist advisers at NICE consider special training to be necessary and to have important implication on safety. 2 In our study, we argue that even in higher risk group of women with clinically large fibroid uterus (measuring ≥16weeks in size and histologically weighing ≥240gms), the surgical risk of LSH is not higher than that of other surgical modalities. The aim of this study is to evaluate the relevance of LSH in the treatment of large uterine fibroids as a safe alternative to total laparoscopic (TLH) and abdominal hysterectomy (AH). Conclusion Since the introduction of laparoscopic hysterectomy by Reich and colleagues in 1989, 3 the number of conventional “open” hysterectomy has slowly declined. However, in the case of large fibroid uterus, often laparoscopic approach is considered impossible mainly with access being the main technical limiting factor. In our study of 53 patients with a mean uterus weight of 467g, 52 patients underwent LSH successfully and the only case where the operation was converted to AH was primarily secondary to the location of the fibroid (broad ligament fibroid) rather than size. Supra- umbilical port were used in all cases and this may have allowed better access in such cases. Laparoscopic techniques for hysterectomy has shown to improve post-operative recovery of patients. A systematic review and meta- analysis reports that the average hospital stay was 2.0 days shorter and patients returned to normal activities 13.6 days earlier with the laparoscopic approach. 1 Previous reports showed a higher risk of urinary tract injury and severe bleeding associated with laparoscopic hysterectomy.1 However, there were no significant intra- operative complications recorded in our study and we reported only one patients who required blood transfusion. This further support our view that LSH is a safe surgical modality for hysterectomy. Pie chart (weight of uterus) Objectives A. ENSEAL® TRIO Tissue Sealing Device B. GYNECARE MORCELLEX™ Tissue Morcellator A B C. Laparoscopic view: Morcellation using fibroid uterus at LSH D. Mean weight of uterus on histology E. Length of hospital stay