BJOG. 2021 May 14. doi: 10.1111/1471-0528.16753. Online ahead of print.
ABSTRACT
OBJECTIVE: To investigate the Large Uterus Classification System (LUCS) ability to predict surgical outcomes and complications in total laparoscopic hysterectomies (TLHs) for large uteri.
DESIGN: Prospective observational study.
SETTING: Two referral centres.
POPULATION OR SAMPLE: 392 women who underwent TLH for a large uterus (uterine fundus at or over the transverse umbilical line).
METHODS: Between 2004 and 2019, the intraoperative LUCS was estimated in all patients. The LUCS considers the uterine and adnexal vascular pedicles displacement. Type 1 is without vascular pedicles displacement. Type 2 has the cephalad displacement of adnexal vascular pedicles. The uterine vessels displacement regardless of adnexal pedicles defines Type 3.
MAIN OUTCOME MEASURES: Patients’ characteristics with perioperative outcomes were prospectively collected and compared between the three types of large uteri.
RESULTS: 251 (64%), 82 (20.9%) and 59 (15.1%) women had Type 1, Type 2, and Type 3 uteri, respectively. Women with Type 1 uteri had a lower uterine weight, shorter operative time, less blood loss, and less complication rates than Type 2 and 3. The conversion rate to laparotomy in Type 1 was similar to Type 2 (OR:0.98;95%CI:0.32-3.56) but lower than Type 3 (OR:0.35;95%CI:0.14-0.97); in Type 2 it was lower than Type 3, although without the conventional statistical significance (OR:0.36;95%CI:0.13-1.13;p=0.07). Multivariable analysis showed that the uterine Type (1 vs. 2-3) was independently associated with the total complications rate (OR:2.00;95%CI:1.09-3.68;p=0.02).
CONCLUSIONS: The LUCS appears associated with surgical outcomes and complications, potentially stratifying the surgical risk and guiding the surgical technique in TLHs for large uteri.
PMID:33988895 | DOI:10.1111/1471-0528.16753
