Comparison between bisection.pdf

ORIGINAL ARTICLE Comparison between bisection/morcellation and myometrial coring for reducing large uteri during vaginal hysterectomy or laparoscopically assisted vaginal hysterectomy: results of a randomized prospective study INTISSAR NAZAH1, FRANc?OIS ROBIN1, JEAN PHILIPPE JAIS2, LOUIS JEFFRY1, LOIC LELIEVRE1, SOPHIE CAMATTE1, ROLAND TAURELLE1 AND FABRICE LECURU1 From the 1Service de Chirurgie Gyne?cologique et Cance?rologique, Ho?pital Europe?en Georges Pompidou, and the 2De?partement d’Informatique Me?dicale, Ho?pital Necker Enfants Malades, Paris, France Acta Obstet Gynecol Scand 2003; 82: 1037–1042. # Acta Obstet Gynecol Scand 82 2003 Background. Vaginal hysterectomy (VH) is being performed increasingly by gynecologic surgeons. Thus, enlarged uteri are more frequently removed vaginally, requiring reducing techniques to allow vaginal extraction. Material and methods. We designed a randomized prospective study to compare bisection–morcellation and myometrial coring. Patients scheduled for VH or laparoscopically assisted vaginal hysterectomy (LAVH) were offered entry into the study. Endometrial cancer was an exclusion criterion. Uterine size was not a contraindication for vaginal surgery. We compared data from preoperative workup as well as from the operative and the postoperative course. Data were recorded prospectively. Results were analyzed with nonparametric tests and logistic regression models. Results. Thirty patients were included in the study. Patients were similar in both groups. No severe peroperative complication occurred in this series. Operating time was comparable in both groups. Uteri weighed more than 280 g in more than 70% of patients in both groups. Myometrial coring failed more often than bisection–morcellation (25% vs. 0%, p? 0.06). Patients and uteri characteristics had no influence on the risk of failure, except for narrow uteri, which were associated with an increased risk of failure in the myometrial coring group only (68.3 vs. 83.9 mm, p?